Fallstricke bei der Zöliakiediagnostik

Zusammenfassung

Eckpfeiler in der Diagnostik der Zöliakie sind nach wie vor die serologische und histologische Diagnostik. Bei den serologischen Tests haben die IgA-Klasse-Endomysium-Antikörper und die Antikörper gegen Gewebstransglutaminase die höchste Sensitivität und Spezifität und sind als gleichwertig einzuschätzen. Ein IgA-Mangel im Serum ist immer auszuschließen. Antigliadin-Antikörper haben aufgrund ihres geringen positiven prädiktiven Wertes außer im jungen Kindesalter keine Bedeutung mehr bei der Diagnostik der Zöliakie. Die histologische Beurteilung von Dünndarmbiopsien sollte standardisiert nach den Marsh-Kriterien erfolgen. Diskrepante serologische und histologische Befunde erfordern eine sachkundige Bewertung durch einen Gastroenterologen und gegebenenfalls eine weiterführende Diagnostik.

Abstract

Both serology and histology remain cornerstones in the diagnosis of coeliac disease. IgA class antibodies against tissue transglutaminase and endomysium have the highest specificity and sensitivity in comparison with other serological tests. An IgA deficiency in serum must always be excluded. Antigliadin antibodies have, because of their low positive predictive value apart from in early childhood, no value as a diagnostic tool in coeliac disease. Intestinal biopsies should be evaluated according to the revised Marsh criteria. A discrepancy between serology and histology requires a competent evaluation by a gastroenterologist and, if necessary, further diagnostic procedures.

Schlüsselwörter

Sprue - Zöliakie - Serologie - Histologie - diskrepante Befunde

Key words

coeliac disease - serology - histology - discrepant findings

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