VIEWS: 6 PAGES: 3 CATEGORY: Medicine POSTED ON: 7/14/2010
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LETTERS TO THE EDITOR termed early clamping. Anecdotally, Discrepancies between histology In all, we agree that it is important not to there has been no evidence of significant and serology for the diagnosis rely on serology alone for the diagnosis of harm to these infants. Scientifically, the of coeliac disease (1) CD, but to allow serology to increase or changes that have been noted are of decrease your estimation of risk of disease. arguable long-term medical conse- Editor – Sweis and colleagues showed However, considering the lifelong implica- quence. If it were clearly detrimental to discrepancies between histology and tions of a diagnosis of CD, one should still the health of the child to perform serology in the diagnosis of coeliac disease maintain a degree of suspicion and also take clamping in one fashion or another, (CD) (Clin Med August 2009 pp 346–8), great care in interpreting villous atrophy in surely legislation would have been insti- and suggest we reduce our reliance on the absence of autoantibodies in any patient. tuted by now. Therefore, we leave the deci- serology testing in diagnosing and sion of when to clamp and collect the excluding CD. However, we feel there are DEVASENAN DEVENDRA cord blood up to the preferences of the major reasons to reconsider this. Consultant physician and honorary senior lecturer mother and her physician or midwife. In The numbers reported here must be NHS Brent, Central Middlesex Hospital our experience, we have not found that interpreted carefully: 10 out of 26 CD and Imperial College, London the difference in time involved makes for patients who received serologic testing were seronegative. This 38.5% occurrence of CHUKWUMA UDUKU a significant difference in collection. seronegative CD is misleading. In the spirit Research assistant and 6th year medical student of Bayes theorem, the more common the Department of Investigative Sciences MOHAMED GABALLA condition we are testing, the greater the per- Imperial College, London Director, Cardiology Research Sun Health Research Institute centage of false negative results.1 In this case, EDWIN LIU Phoenix, AZ, USA all 26 patients were selected due to the diag- Associate professor, pediatrics nosis of CD, meaning the prevalence in this Section of Gastroenterology, DAVID T HARRIS group was already 100%. Therefore, this Hepatology and Nutrition Professor of immunobiology group is bound to have a high number of The Children’s Hospital, Director, Stem Cell Bank false negative tests. The authors correctly University of Colorado at Denver The University of Arizona state that a small number of cases of CD will Tucson, AZ, USA YANNOULLA WILSON be missed by relying on serology alone, but Laboratory manager, Autoimmune Serology NATHAN COPELAND the true prevalence is unknown, and this Northwest London Hospitals NHS Trust Medical student, MD-Candidate Class of 2012 number is likely to be much lower than 38.5%. The University of Arizona In addition, the predictive value of using Tucson, AZ, USA an ELISA-based method to detect tissue References transglutaminase autoantibody (tTG) 1 Shapiro D. The interpretation of diagnostic remains open to discussion. There are tests. Stat Methods Med Res 1999; currently numerous tTG assays available, 8(2):113–34. References all with varying performances. The 2 Li M, Yu L, Tiberti C et al. A report 1 Meier C, Middelanis J, Wasielewski B et al. International tTG Workshop for CD on the International Transglutaminase Spastic paresis after perinatal brain damage Autoantibody Workshop for Celiac Disease. performed head-to-head comparisons of in rats is reduced by human cord blood Am J Gastroenterol 2009;104:154–63. various commercial and laboratory-based 3 Bonamico M, Mariani P, Thanasi E et al. mononuclear cells. Pediatr Res 2006;59:244–9. tTG assays. For this workshop, assays Patchy villous atrophy of the duodenum in 2 Ceriani Cernadas JM, Carroli G, Pellegrini L reported sensitivities ranging from 82% to childhood celiac disease. J Pediatr et al. The effect of timing of
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