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" Prophylactic administration of aminophylline plus dexamethasone reduces post - dural puncture headache beter than using each drug alone in patients undergoing lower extremity surgery "
/مرضیه حمیدی
; Khosrou Naghibi
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Isfahan University of Medical Sciences
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| Document Type
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Latin Dissertation
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English
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| Record Number
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102700
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| Doc. No
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T11336
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WD,175,K18d,2008
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| Main Entry
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Karimi, Somayeh
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| Title & Author
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Diagnostic Accuracy of IgA anti- Tissue Transglutaminase in Patients Snspected of Having Coeliac Disease in Iran. Somayeh Karimi/سمیه کریمی
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| College
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Schools, Medical
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| Date
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, 2008
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| Degree
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Medicine, MD
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[ Not Paging ]
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| Note
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This thesis is also a research Project with Project ID 82398 and also presented as a paper in " J. Gastrointestin. Liver Dis. 2008, june, 17 (2): 141-6
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Original Works
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| Abstract
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Background and aim. As there are little data about the sensitivity of the IgA anti-tissue transglutaminase (IgA anti-tTG) antibody test in the clinical practice setting, we evaluated the sensitivity of this serologic test in a group of patients who were suspected of having coeliac disease and had serologic testing performed at commercial laboratories. Patients and methods. The study was performed at Poursina Hakim Research Institute in Isfahan-Iran. A total number of 350 consecutive patients were enrolled in our study. They were divided into 3 groups: classical mode of presentation, atypical mode of presentation and patients with non specific prolonged gastrointestinal symptoms. Upper gastrointestinal endoscopy, histopathologic examination of biopsies from the second part of duodenum and serologic evaluation were performed for every patient. Biopsy specimens were evaluated according to Marsh (1992, revised in 1997). Results. The overall sensitivity and specificity of IgA anti-tTG antibody were 38 and 98 . The positive and negative predictive values for the anti-tTG antibodies were 57 and 96 , respectively. The sensitivity was 80 in patients with Marsh IIIC. Conclusion. In contrast to other reports suggesting a diagnostic accuracy of more than 90 for anti-tTG antibody in coeliac disease patients, our data showed that we are still far from an ideal screening serologic tool which can rely on the antibody test as the sole way of identifying patients with coeliac disease. This could result in many missed diagnoses, in particular in patients with lesser degrees of Marsh classification.Introduction Coeliac disease (CD) is a genetically determined autoimmune-like disorder induced by gluten, the storage protein ofwheat and by similar proteins found in barley and rye [1. 2]. It has a strong genetic background, as suggested clearly by studies on first-degree relatives of coeliac patients, on twins and on H1,A genes associated with the susceptibility for the disease [3, 4]. Serological screening in healthy volunteers around the world has estimated the prevalence of CD to be about 0.5-1.0 [I, 3, 5-11]. Prevalence of CD is also shown to be as high as 1/166 among healthy blood donors in Iran [1 I ]. Although the diagnosis of CD may be suspected on clinical or laboratory grounds, including the result of serological tests, the histology of the small intestinal mucosa is still the diagnostic gold standard [12, 13]. The presence of a Marsh III lesion (villous atrophy) on duodenal biopsy together with a positive antibody test is internationally accepted as CD, although antibody negative CD does exist [14-16]. Patients known to have CD have to undergo a life-long gluten free diet (GFD), and gluten withdrawal from the diet generally leads to complete recovery of the morphological changes [17]. Over the past few decades, population based serological studies have changed our knowledge on both the clinical pattern and epidemiology of CD. Monosymptomatic, oligosymptomatic, atypical (without gastrointestinal symptoms), silent and latent forms of CD have been identified [3, 4, 18, 19]. Clinical presentation can be diarrhea predominant, the so called classical presentation, atypical with patients presenting in many atypical ways or it may be asymptomatic, the so called silent cases [20-22]. Because CD now often presents atypically, it is underdiagnosed. It is suggested that the detection rate may be increased by 12 if serology is used to identify cases of occult enteropathy [23, 24]. Several serologic tests have been developed to detect patients with CD: antigliadin IgG antibodies have a poor specificity, antigliadin IgA antibodies a poor sensitivity.Key words: Anti-tissue transglutaminase antibody ت coeliac disease ت duodenal biopsy ت sensitivity.
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| Descriptor
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1. Celiac Disease- diagnosis.- Descriptors: Celiac Disease
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IgA Deficiency
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Transglutaminases
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Celiac Plexus
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Serologic Tests
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Antigen- diagnostic use
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Transaminases
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Emami, MohammadHasan, Supervisor
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| Translated Title Supplied by Cataloguer
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بررسی ارزش تشخیصی آنتی بادی ضد ترانس گلوتامیناز بافتی در بیماران مشکوک به بیماری سلیاک در ایران
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