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

Ahmed Mahmood Ruby; Randa Al-Khodary; Mohammad Shubair; Mahmoud Sirdah

doi:doi:10.11648/j.ajbio.20140206.11

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

Ahmed Mahmood Ruby, Randa Al-Khodary, Mohammad Shubair, Mahmoud Sirdah

Published in American Journal of BioScience (Volume 2, Issue 6)

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.
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[8]	The American Celiac disease alliance http://americanceliac.org/celiac-disease/diagnosis/.
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[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.
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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

Ahmed Mahmood Ruby

The Central Laboratories, Ministry of Health, Gaza Strip, Palestine
Randa Al-Khodary

The Central Laboratories, Ministry of Health, Gaza Strip, Palestine
Mohammad Shubair

Medical Technology Department, The Islamic University of Gaza, Gaza Strip, Palestine
Mahmoud Sirdah

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

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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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