Patients with chronic cryptogenic hypertransaminasemia are at high risk of developing celiac disease (CD). In fact, among the various serological disorders, CD patients at onset frequently present hypertransaminasemia. In this study, we evaluated usefulness and reliability of the new test for antitissue transglutaminase (tTG) in screening for CD as well as in estimating the prevalence of CD in a population of blood donors presenting unexplained hypertransaminasemia at donation. Controls were 180 consecutive healthy donors without hypertransaminasemia and 20 CD patients with known antiendomysial antibody (EmA) positivity. Out of 22,204 blood donors over a period of 2 years, we found 258 subjects (1.2%) with cryptogenic hypertransaminasemia. Four of these subjects (1.5%) were positive for anti-tTG, but only 3 of them were positive for EmA. EmA were negative in all the remaining hypertransaminasemia subjects. In the control groups, anti-tTG antibodies were negative in all the 180 healthy donors without hypertransaminasemia, but positive in all the CD patients known to be EmA positive. 3 of the 4 subjects positive for anti-tTG, including 2 who were also EmA positive, underwent biopsy of the distal duodenal mucosa which showed a picture compatible with CD only in the 2 patients with concomitant EmA positivity. After 3 months of gluten-free diet, the serum transaminase values normalized in these 2 patients. In conclusion, the prevalence of CD in our blood bank population was lower than that reported in other similar studies, but the new test for anti-tTG showed a good sensitivity and reliability, and, therefore, it can be proposed as a first-level test in screening for CD in selected populations such as subjects with hypertransaminasemia.

1.
Bardella MT, Fraquelli M, Quatrini M, Molteni N, Bianchi P, Conte D: Prevalence of hypertransaminasemia in adult celiac patients and effect of gluten-free diet. Hepatology 1995;22:833–836.
[PubMed]
2.
Leonardi S, Bottaro G, Patane R, Musumeci S: Hypertransaminasemia as the first symptom in infant celiac disease. J Pediatr Gastroenterol Nutr 1990;11:404–406.
[PubMed]
3.
Gonzalez-Abraldes J, Sanchez-Fueyo A, Bessa X, Moitinho E, Feu F, Mas A, Escorsell A, Bruguera M: Persistent hypertransaminasemia as the presenting feature of celiac disease. Am J Gastroenterol 1999;94:1095–1097.
[PubMed]
4.
Vajro P, Fontanella A, Mayer M, De Vincenzo A, Terracciano LM, D’Armiento M, Vecchione R: Elevated serum aminotransferase activity as an early manifestation of gluten-sensitive enteropathy. J Pediatr 1993;122:416–419.
[PubMed]
5.
Bardella MT, Vecchi M, Conte D, Del Ninno E, Fraquelli M, Pacchetti S, Minola E, Landoni M, Cesana BM, De Franchis R: Chronic unexplained hypertransaminasemia may be caused by occult celiac disease. Hepatology 1999;29:654–657.
[PubMed]
6.
Catassi C, Ratsch IM, Fabiani E, Rossini M, Bordicchia F, Candela F, Coppa GV, Giorgi PL: Coeliac disease in the year 2000: Exploring the iceberg. Lancet 1994;343:200–203.
[PubMed]
7.
Corazza GR, Andreani ML, Biagi F, Corrao G, Pretolani S, Giulianelli G, Ghironzi G, Gasbarrini G: The smaller size of the ‘coeliac iceberg’ in adults. Scand J Gastroenterol 1997;32:917–919.
[PubMed]
8.
Grodzinsky E, Franzen L, Hed J, Strom M: High prevalence of celiac disease in healthy adults revealed by antigliadin antibodies. Ann Allergy 1992;69:66–70.
[PubMed]
9.
Johnston SD, Watson RPG, McMillan SA, Love AHG: Prevalence of celiac disease in Northern Ireland. Lancet 1997;1350:1370.
10.
Weile B, Grodzinsky E, Skogh T, Jordal R, Cavell B, Krasilnikoff PA: Screening Danish blood donors for antigliadin and antiendomysium antibodies. Acta Paediatr Suppl 1996;412:446.
11.
Grodzinsky E: Screening for celiac disease in apparently healthy blood donors. Acta Paediatr Suppl 1996;412:36–38.
[PubMed]
12.
Not T, Horvath K, Hill ID, Partanen J, Hammed A, Magazzu G, Fasano A: Celiac disease risk in the USA: High prevalence of antiendomysium antibodies in healthy blood donors. Scand J Gastroenterol 1998;33:494–498.
[PubMed]
13.
Gandolfi L, Pratesi R, Cordoba JC, Tauil PL, Gasparin M, Catassi C: Prevalence of celiac disease among blood donors in Brazil. Am J Gastroenterol 2000;95:689–692.
[PubMed]
14.
Dieterich W, Ehnis T, Bauer M, Donner P, Volta U, Riecken EO, Schuppan D: Identification of tissue transglutaminase as the autoantigen of celiac disease. Nat Med 1997;3:797–801.
[PubMed]
15.
Sulkanen S, Halttunen T, Laurila K, Kolho K, Korponay-Szabo I, Sarnesto A, Savilahti E, Collin P, Maki M: Tissue transglutaminase autoantibody enzyme-linked immunosorbent assay in detecting celiac disease. Gastroenterology 1998;115:1322–1328.
[PubMed]
16.
Troncone R, Maurano F, Rossi M, Micillo M, Greco L, Auricchio R, Salerno G, Salvatore F, Sacchetti L: IgA antibodies to tissue transglutaminase: An effective diagnostic test for celiac disease. J Pediatr 1999;134:166–171.
[PubMed]
17.
Brusco G, Izzi L, Corazza GR: Tissue transglutaminase antibodies for coeliac disease screening. Ital J Gastroenterol Hepatol 1998;30:496–497.
[PubMed]
18.
Dieterich W, Laag E, Schopper H, Volta U, Ferguson A, Gillet H, Riecken EO, Schuppan D: Autoantibodies to tissue transglutaminase as predictors of celiac disease. Gastroenterology 1998;115:1317–1321.
[PubMed]
19.
Walker-Smith JA, Guandalini S, Schmitz J, Shmerling DH, Visakorpi JK: Revised criteria for diagnosis of coeliac disease. Arch Dis Child 1990;65:909–911.
[PubMed]
20.
Carroccio A, Iannitto E, Cavataio F, Montalto G, Tumminello M, Campagna P, Lipari MG, Notarbartolo A, Iacono G: Sideropenic anemia and celiac disease: One study, two points of view. Dig Dis Sci 1998;43:673–678.
[PubMed]
21.
Carroccio A, Cavataio F, Iacono G, Agate V, Ippolito S, Kazmierska I, Campagna P, Soresi M, Montalto G: IgA antiendomysial antibodies on the umbilical cord in diagnosing celiac disease. Scand J Gastroenterol 1996;31:759–763.
[PubMed]
22.
Hagander B, Brandt L, Sjölund K, Berg NO, Norden A, Stenstam M: Hepatic injury in celiac disease. Lancet 1977;ii:270–272.
23.
Bonamico M, Pitzalis G, Culasso F: Hepatic damage during coeliac disease in childhood. Minerva Pediatr 1986;38:959–962.
[PubMed]
24.
Ventura A, Magazzù G: Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease. Gastroenterology 1999;117:297–303.
[PubMed]
25.
Schuppan D: Current concepts of celiac disease pathogenesis. Gastroenterology 2000;119:234–242.
[PubMed]
26.
Sjöberg K, Lindgren S, Eriksson S: Frequent occurrence of non-specific gliadin antibodies in chronic liver disease: Endomysial but not gliadin antibodies predict coeliac disease in patients with chronic liver disease. Scand J Gastroenterol 1997;32:1162–1167.
[PubMed]
27.
Catassi C, Ratsch IM, Fabiani E, Ricci S, Bordicchia F, Pierdomenico R, Giorgi PL: High prevalence of undiagnosed CD in 5280 Italian students screened by antigliadin antibodies. Acta Paediatr 1995;84:672–676.
[PubMed]
28.
Ramos Pla M, Julve Pardo R, Primo Vera J, Fernandez Chinchilla J, Gomez Belda AB, Garcia Ferrer L: Hypertransaminasemia: Indication for the diagnosis of celiac disease (in Spanish). Gastroenterol. Hepatol. 1999;22:501–504.
29.
Trevisiol C, Not T, Berti I, Buratti E, Città A, Neri E, Torre G, Martelossi S, Tommasini A, Alu A, Barillari G, Facchini S, Ventura A: Screening for coeliac disease in healthy blood donors at two immuno-transfusion centres in north-east Italy. Ital J Gastroenterol Hepatol 1999;31:584–586.
[PubMed]
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