Forty-Eight Hours of Biopsy Culture Improve the Sensitivity of the in Vitro Gliadin Challenge in the Diagnosis of Celiac Disease

Celiac disease (CD) is a long-life intolerance to gliadin in genetically susceptible individuals (1)(2)(3)(4)(5)(6). Despite contrary views (7), diagnosis is still based on the histologic findings of intestinal mucosal atrophy with crypt hyperplasia in individuals on a gluten-containing diet and a return to normal after a gluten-free diet (GFD). The presence of circulating anti-endomysial antibodies (EMAs) and their disappearance after GFD confirm the diagnosis (8)(9)(10). It has recently been shown that EMAs are produced by intestinal mucosa of CD patients. EMAs disappear in treated CD patients but are newly produced after in vitro exposure of intestinal biopsy samples to gliadin (11). Culture of intestinal mucosa from treated CD patients in the presence of a peptic-tryptic (PT) digest of gliadin for 24 h frequently fails to produce detectable EMAs, but it has high specificity as well as high sensitivity in overt CD (12). Our aim was to increase the sensitivity of the in vitro culture by prolonging the duration to 48 h. We also tested a new culture method in batch to ease testing. We enrolled 11 untreated, EMA-positive CD patients (5 males and 6 females; mean age, 24.7 years; age range, 17–42 years) and 29 treated CD patients (11 males and 18 females; mean age, 32.0 years; age range, 11–70 years) after at least 12 months of GFD (median length of GFD, 730 days; range, 342–4015 days) and two monthly, consecutive serum EMA tests that were negative. As disease-controls we studied 67 patients (20 males and 47 females, mean age, 35.3 years; age range, 20–50 years) with gastrointestinal diseases other than CD (42 with gastroesophageal reflux disease, 8 with ulcer disease, 3 with ulcerative colitis, 3 with Crohn disease, 2 with lymphoma, 1 with small …