Special Precautions/Comments:

Method: Indirect Immunofluorescence (IIF). Calibration: N/A. EQA scheme: UK NEQAS scheme for Coeliac disease antibodies. IQC: Commercial preparation

Interferences: Negative results may be observed in coeliac disease patients who are IgA deficient.

Interpretation: Results are reported as being: NEGATIVE, WEAK POSITIVE, POSITIVE or STRONG POSITIVE. While highly specific for Coeliac disease, the IgA Endomysial antibody will be negative in IgA deficient individuals – (as will the IgA anti tissue transglutaminase test).

Additional Information:

Indication: Confirmation of Positive tTG results less than 50.

Background Information: IgA endomysial antibodies (IgA EMA) react with the reticulin component of smooth muscle endomysium and are indicative of gluten sensitive enteropathy. IgA anti-endomysial is more specific than IgA tissue transglutaminase antibodies but both are reportedly of equal sensitivity [1]. IgA endomysial antibodies are poor predictors of villous recovery [1]. There has been a long standing controversy over the optimal testing strategy for patients with suspected coeliac disease however the NICE guidelines in 2009 recommend IgA tissue transglutaminase antibodies as a first line test followed by IgA endomysial antibodies if the IgA TGT is equivocal [2]. Patients with positive serology should be referred to gastroenterology for a duodenal biopsy, the current gold standard for the diagnosis of coeliac disease. Seronegative coeliac disease occurs in a small proportion of patients (6.4%) [1]. Patients with a negative serology who continue to have a high clinical suspicion of coeliac disease should be referred to gastroenterology [2].

References: NICE clinical guideline 86: Recognition and assessment of coeliac disease. 2009. [Ref 2] Hopper AD, et al. What is the role of serologic testing in coeliac disease? A prospective, biopsy-confirmed study with economic analysis. Clinical Gastroenterology and Hepatology. 2008. 6:314-320. [Ref 1] Hopper AD, et al. Pre-endoscopy serological testing for coeliac disease:evaluation of a clinical decision tool. BMJ. 2007. 334:729. Hopper AD, et al. Adult coeliac disease. BMJ. 2007. 335: 558-562. Heel DA, West J. Recent advances in coeliac disease. Gut. 2006. 55:1037-1046. Rostom A, et al. The diagnostic accuracy of serologic tests for coeliac disease: a systematic review. 2005. 128(4):S38-46.

See Also: Tissue transglutaminase

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