{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T06:43:57Z","timestamp":1777445037632,"version":"3.51.4"},"reference-count":12,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T00:00:00Z","timestamp":1750377600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Biochem"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Current coeliac disease (CD) NICE guidelines recommend testing IgA-endomysial antibodies (EMA) following a weak-positive IgA-tissue transglutaminase antibody (tTGA). Outside of patients with very high IgA-tTGA results, a positive IgA-EMA necessitates duodenal biopsy to confirm CD diagnosis, meaning a positive IgA-EMA does not alter the diagnostic pathway. Therefore, to be helpful, a negative IgA-EMA needs to reliably exclude CD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We aimed to evaluate the negative predictive value (NPV) of IgA-EMA, following a weak-positive\/positive IgA-tTGA, and to evaluate whether IgA-EMA result (positive or negative) affects duodenal biopsy rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Retrospective patient cohort (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 963) study of patients with IgA-EMA and IgA-tTGA testing, with or without evidence of duodenal biopsy. The NPV of IgA-EMA was assessed by comparison to duodenal biopsy. Duodenal biopsy rates were compared between patients with a positive\/negative IgA-EMA (after positive\/weak-positive IgA-tTGA).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The NPVs for CD of a negative IgA-EMA, in the context of a weak-positive or positive IgA-tTGA, were 41% and 0%, respectively (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 45). There was a significant reduction in the proportion of patients who had a duodenal biopsy with a negative IgA-EMA (9.4%) compared to patients with a positive IgA-EMA (28.5%), following a positive\/weak-positive IgA-tTGA (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 963).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>IgA-EMA does not reliably exclude CD following a positive\/weak-positive IgA-tTGA result. Our data indicates that clinicians are utilizing a negative IgA-EMA, following a positive\/weak-positive IgA-tTGA result, to inappropriately exclude CD. We recommend IgA-EMA be exclusively used in the context of a \u2018non-biopsy\u2019 approach to CD diagnosis, following a high positive IgA-tTGA, and that a negative IgA-EMA result should not be used to exclude CD in the context of a weak-positive\/positive IgA-tTGA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00045632251350488","type":"journal-article","created":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T05:03:43Z","timestamp":1749618223000},"page":"32-39","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Is there utility in testing IgA-endomysial antibodies in patients with weak-positive or equivocal IgA-tissue transglutaminase antibodies in the diagnosis of coeliac disease? A critique of current NICE guidance (NG20)"],"prefix":"10.1177","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4717-9621","authenticated-orcid":false,"given":"Samuel D","family":"Brown","sequence":"first","affiliation":[{"name":"Royal Sussex County Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline","family":"Hitchins","sequence":"additional","affiliation":[{"name":"University Hospitals Bristol and Weston NHS Foundation Trust"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9537-4106","authenticated-orcid":false,"given":"Newton ACS","family":"Wong","sequence":"additional","affiliation":[{"name":"North Bristol NHS Trust"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Hayes","sequence":"additional","affiliation":[{"name":"University Hospitals Bristol and Weston NHS Foundation Trust"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Ogden","sequence":"additional","affiliation":[{"name":"North Bristol NHS Trust"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Heaps","sequence":"additional","affiliation":[{"name":"North Bristol NHS Trust"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Bright","sequence":"additional","affiliation":[{"name":"North Bristol NHS Trust"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,6,20]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-019-1380-z"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.3109\/07853890.2010.505931"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/gut.33.12.1633"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2000.02018.x"},{"key":"e_1_3_3_6_2","volume-title":"Recommendations | Coeliac disease: recognition, assessment and management | Guidance","author":"NICE","year":"2015","unstructured":"NICE. Recommendations | Coeliac disease: recognition, assessment and management | Guidance. NICE, 2015. https:\/\/www.Nice.org.uk. https:\/\/www.nice.org.uk\/guidance\/ng20\/chapter\/Recommendations#referral-of-people-with-suspected-coeliac-disease (accessed 4 February 2025)."},{"key":"e_1_3_3_7_2","volume-title":"How should I assess a person with suspected coeliac disease?","author":"NICE","year":"2020","unstructured":"NICE. How should I assess a person with suspected coeliac disease? NICE, 2020. https:\/\/cks.nice.org.uk\/topics\/coeliac-disease\/diagnosis\/assessment\/ (accessed 4 February 2025)."},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000002497"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/flgastro-2020-101624"},{"key":"e_1_3_3_10_2","first-page":"181","article-title":"The measurement of IgA and IgG transglutaminase antibodies in celiac disease: a comparison with current diagnostic methods","volume":"32","author":"Reeves GEM","year":"2000","unstructured":"Reeves GEM, Burns C, Hall ST, et al. The measurement of IgA and IgG transglutaminase antibodies in celiac disease: a comparison with current diagnostic methods. Pathology (Phila, Pa) 2000; 32: 181\u2013185.","journal-title":"Pathology (Phila, Pa)"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cccn.2005.01.015"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jim.2020.112910"},{"key":"e_1_3_3_13_2","first-page":"9","article-title":"Positive tissue transglutaminase antibodies with negative endomysial antibodies: low rate of celiac disease","volume":"6","author":"Weiss B","year":"2004","unstructured":"Weiss B, Yoram B, Avidan B, et al. Positive tissue transglutaminase antibodies with negative endomysial antibodies: low rate of celiac disease. Isr Med Assoc J 2004; 6: 9\u201312.","journal-title":"Isr Med Assoc J"}],"container-title":["Annals of Clinical Biochemistry: International Journal of Laboratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00045632251350488","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00045632251350488","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00045632251350488","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:25:40Z","timestamp":1777379140000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00045632251350488"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,20]]},"references-count":12,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1177\/00045632251350488"],"URL":"https:\/\/doi.org\/10.1177\/00045632251350488","relation":{},"ISSN":["0004-5632","1758-1001"],"issn-type":[{"value":"0004-5632","type":"print"},{"value":"1758-1001","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,20]]}}}