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Immunodiagnosis of Celiac Disease among Children with Chronic Diarrhea in Gaza Strip, Palestine

Received: 31 August 2014     Accepted: 8 September 2014     Published: 30 October 2014
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Abstract

Celiac disease (CD) is a permanent intolerance to gluten that results in damage to the mucosa of the small intestine. The prevalence of CD in developing countries may be undervalued due to different factors, but lack of awareness and low suspicion of the disease could be the main factors. The aim of the present work was to estimate the occurrence of CD among children suffering from chronic diarrhea in Gaza Strip and to adopt dependable non -invasive immunological techniques for diagnosis of CD in the laboratories of the Ministry of Health. This study was conducted on children (6-96 months) suffering from frequent (>3times/day) chronic diarrhea that not caused by infection. The study population comprised 123 symptomatic Palestinian children. Five ml peripheral blood were collected, sera were separated and stored at -70 ⁰C until performing the following assays: IgA Anti-endomysial antibodies(EMAs) using indirect immunofluorescence technique (IF), anti- tissue transglutaminase enzyme antibodies (tTG, IgG, IgA) and (tTG, IgA) using ELISA technique, anti smooth muscle antibodies (ASMA) using indirect immunofluorescence and total IgA using radial immunodiffusion (RID). The prevalence of CD using EMAs test was 3.25% but 12.2% when (tTG IgG, IgA) assay was applied. However, the prevalence of ASMA was 28.5% which may mask the EMAs antibodies and hence giving false negative results of EMAs. Our results showed comparable sensitivity of both (tTG IgG, IgA) and EMAs. Deficient or low IgA represented 33.3% of all (tTG IgG, IgA) positive samples. It was concluded that EMAs and (tTG IgG, IgA) tests could be used as noninvasive techniques on children suffering from CD. However for those having low or IgA deficiency, the class IgG of EMAs and tTG should be performed.

Published in American Journal of BioScience (Volume 2, Issue 6)
DOI 10.11648/j.ajbio.20140206.11
Page(s) 192-195
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2014. Published by Science Publishing Group

Keywords

Celiac Disease, Tissue Transglutaminase Antibodies, Anti-Endomysial Antibodies, Antismooth Muscle Antibodies,Gaza Strip.

References
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[2] Ferguson A. (1997). Celiac disease, an eminently treatable condition, may be underdiagnosed in the United States. The American journal of gastroenterology 92(8):1252-1254.
[3] Antonioli DA. (2003). Celiac disease: a progress report. Modern Pathology 16(4):342-346.
[4] Mazzarella G, Maglio M, Paparo F, Nardone G, Stefanile R, Greco L, van de Wal Y, Kooy Y, Koning F, Auricchio S, Troncone R.. (2003). An immunodominant DQ8 restricted gliadin peptide activates small intestinal immune response in in vitro cultured mucosa from HLA-DQ8 positive but not HLA-DQ8 negative coeliac patients. Gut 52(1):57-62.
[5] Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PH, Guandalini S, Hill ID, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K. (2003). Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Archives of internal medicine 163(3):286-292.
[6] Barada K, Bitar A, Mokadem MA, Hashash JG, Green P. (2010). Celiac disease in Middle Eastern and North African countries: a new burden?. World Journal Gastroenterology 16(12):1449-57.
[7] Barada K, Abu Daya H, Rostami K, Catassi C. (2012). Celiac disease in the developing world. Gastrointest Endosc Clin N Am 22(4):773-96.
[8] The American Celiac disease alliance http://americanceliac.org/celiac-disease/diagnosis/.
[9] National Institutes of Health Consensus Development Conference on Celiac Disease: final statement. June 28–30, 2004. Available at (http://consensus.nih.gov/2004/2004CeliacDisease118html.htm)
[10] Aetna. Clinical Policy Bulletin: Celiac Disease Laboratory Testing. Number: 0561 http://www.aetna.com/cpb/medical/data/500_599/0561.html
[11] Tesija Kuna A. (2009). Laboratory diagnosis of autoimmune disease. Biochemia Medica 19 (suppl 1): S21-S22.
[12] Chirdo FG, Rumbo M, Carabajal P, Castagnino N, Mavromatopulos E, Cirincione V, Anon MC, Fossati CA (1999). Analysis of anti-gliadin antibodies by immunoblot analysis and enzyme-linked immunosorbent assay using gliadin fractions as antigens. Journal of Pediatric Gastroenterology and Nutrition 29(2):171-177.
[13] Not T, Horvath K, Hill ID, Partanen J, Hammed A, Magazzu G, Fasano A. (1998). Celiac disease risk in the USA: high prevalence of antiendomysium antibodies in healthy blood donors. Scandinavian Journal of gastroenterology 33(5):494-498.
[14] Llorente MJ, Sebastian M, Fernandez-Acenero MJ, Serrano G, Villanueva S. (2004). IgA antibodies against tissue transglutaminase in the diagnosis of celiac disease: concordance with intestinal biopsy in children and adults. Clinical Chemistry 50(2):451-453.
[15] Lasagni D, Ferrari R, Lapini M. (1999). Unmasking anti-endomysial antibodies in coeliac subjects positive for anti-smooth muscle antibodies. Acta Paediatrica 88(4):462-464.
[16] Kumar V, Jarzabek-Chorzelska M, Sulej J, Karnewska K, Farrell T, Jablonska S. (2002). Celiac disease and immunoglobulin a deficiency: how effective are the serological methods of diagnosis? Clinical and Diagnostic Laboratory Immunology 9(6):1295-1300.
[17] Korponay-Szabo IR, Dahlbom I, Laurila K, Koskinen S, Woolley N, Partanen J, Kovacs JB, Maki M, Hansson T. (2003). Elevation of IgG antibodies against tissue transglutaminase as a diagnostic tool for coeliac disease in selective IgA deficiency. Gut 52(11):1567-1571.
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Cite This Article
  • APA Style

    Ahmed Mahmood Ruby, Randa Al-Khodary, Mohammad Shubair, Mahmoud Sirdah. (2014). Immunodiagnosis of Celiac Disease among Children with Chronic Diarrhea in Gaza Strip, Palestine. American Journal of BioScience, 2(6), 192-195. https://doi.org/10.11648/j.ajbio.20140206.11

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    ACS Style

    Ahmed Mahmood Ruby; Randa Al-Khodary; Mohammad Shubair; Mahmoud Sirdah. Immunodiagnosis of Celiac Disease among Children with Chronic Diarrhea in Gaza Strip, Palestine. Am. J. BioScience 2014, 2(6), 192-195. doi: 10.11648/j.ajbio.20140206.11

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    AMA Style

    Ahmed Mahmood Ruby, Randa Al-Khodary, Mohammad Shubair, Mahmoud Sirdah. Immunodiagnosis of Celiac Disease among Children with Chronic Diarrhea in Gaza Strip, Palestine. Am J BioScience. 2014;2(6):192-195. doi: 10.11648/j.ajbio.20140206.11

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  • @article{10.11648/j.ajbio.20140206.11,
      author = {Ahmed Mahmood Ruby and Randa Al-Khodary and Mohammad Shubair and Mahmoud Sirdah},
      title = {Immunodiagnosis of Celiac Disease among Children with Chronic Diarrhea in Gaza Strip, Palestine},
      journal = {American Journal of BioScience},
      volume = {2},
      number = {6},
      pages = {192-195},
      doi = {10.11648/j.ajbio.20140206.11},
      url = {https://doi.org/10.11648/j.ajbio.20140206.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajbio.20140206.11},
      abstract = {Celiac disease (CD) is a permanent intolerance to gluten that results in damage to the mucosa of the small intestine. The prevalence of CD in developing countries may be undervalued due to different factors, but lack of awareness and low suspicion of the disease could be the main factors. The aim of the present work was to estimate the occurrence of CD among children suffering from chronic diarrhea in Gaza Strip and to adopt dependable non -invasive immunological techniques for diagnosis of CD in the laboratories of the Ministry of Health. This study was conducted on children (6-96 months) suffering from frequent (>3times/day) chronic diarrhea that not caused by infection. The study population comprised 123 symptomatic Palestinian children. Five ml peripheral blood were collected, sera were separated and stored at -70 ⁰C until performing the following assays: IgA Anti-endomysial antibodies(EMAs) using indirect immunofluorescence technique (IF), anti- tissue transglutaminase enzyme antibodies (tTG, IgG, IgA) and (tTG, IgA) using ELISA technique, anti smooth muscle antibodies (ASMA) using indirect immunofluorescence and total IgA using radial immunodiffusion (RID). The prevalence of CD using EMAs test was 3.25% but 12.2% when (tTG IgG, IgA) assay was applied. However, the prevalence of ASMA was 28.5% which may mask the EMAs antibodies and hence giving false negative results of EMAs. Our results showed comparable sensitivity of both (tTG IgG, IgA) and EMAs. Deficient or low IgA represented 33.3% of all (tTG IgG, IgA) positive samples. It was concluded that EMAs and (tTG IgG, IgA) tests could be used as noninvasive techniques on children suffering from CD. However for those having low or IgA deficiency, the class IgG of EMAs and tTG should be performed.},
     year = {2014}
    }
    

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  • TY  - JOUR
    T1  - Immunodiagnosis of Celiac Disease among Children with Chronic Diarrhea in Gaza Strip, Palestine
    AU  - Ahmed Mahmood Ruby
    AU  - Randa Al-Khodary
    AU  - Mohammad Shubair
    AU  - Mahmoud Sirdah
    Y1  - 2014/10/30
    PY  - 2014
    N1  - https://doi.org/10.11648/j.ajbio.20140206.11
    DO  - 10.11648/j.ajbio.20140206.11
    T2  - American Journal of BioScience
    JF  - American Journal of BioScience
    JO  - American Journal of BioScience
    SP  - 192
    EP  - 195
    PB  - Science Publishing Group
    SN  - 2330-0167
    UR  - https://doi.org/10.11648/j.ajbio.20140206.11
    AB  - Celiac disease (CD) is a permanent intolerance to gluten that results in damage to the mucosa of the small intestine. The prevalence of CD in developing countries may be undervalued due to different factors, but lack of awareness and low suspicion of the disease could be the main factors. The aim of the present work was to estimate the occurrence of CD among children suffering from chronic diarrhea in Gaza Strip and to adopt dependable non -invasive immunological techniques for diagnosis of CD in the laboratories of the Ministry of Health. This study was conducted on children (6-96 months) suffering from frequent (>3times/day) chronic diarrhea that not caused by infection. The study population comprised 123 symptomatic Palestinian children. Five ml peripheral blood were collected, sera were separated and stored at -70 ⁰C until performing the following assays: IgA Anti-endomysial antibodies(EMAs) using indirect immunofluorescence technique (IF), anti- tissue transglutaminase enzyme antibodies (tTG, IgG, IgA) and (tTG, IgA) using ELISA technique, anti smooth muscle antibodies (ASMA) using indirect immunofluorescence and total IgA using radial immunodiffusion (RID). The prevalence of CD using EMAs test was 3.25% but 12.2% when (tTG IgG, IgA) assay was applied. However, the prevalence of ASMA was 28.5% which may mask the EMAs antibodies and hence giving false negative results of EMAs. Our results showed comparable sensitivity of both (tTG IgG, IgA) and EMAs. Deficient or low IgA represented 33.3% of all (tTG IgG, IgA) positive samples. It was concluded that EMAs and (tTG IgG, IgA) tests could be used as noninvasive techniques on children suffering from CD. However for those having low or IgA deficiency, the class IgG of EMAs and tTG should be performed.
    VL  - 2
    IS  - 6
    ER  - 

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Author Information
  • The Central Laboratories, Ministry of Health, Gaza Strip, Palestine

  • The Central Laboratories, Ministry of Health, Gaza Strip, Palestine

  • Medical Technology Department, The Islamic University of Gaza, Gaza Strip, Palestine

  • Faculty of Science, Al-Azhar University, Gaza Strip, Palestine

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