Which serology tests look for autoantibodies in celiac disease?

• A. Anti-endomysial antibody (EMA-IgA) and Anti-tTG-IgA/tTG-IgG
• B. Anti-nuclear antibodies
• C. Deamidated gliadin peptide IgG only
• D. Celiac disease DNA test

Answer: (A)

Serology in celiac disease centers on detecting autoantibodies against components of the gluten-triggered immune response, mainly endomysial antigens and tissue transglutaminase. The most informative combination is anti-endomysial antibodies (EMA) of the IgA class and anti-tissue transglutaminase antibodies (tTG), with the tTG tests available as IgA or IgG. EMA-IgA is highly specific for celiac disease, and tTG-IgA offers high sensitivity and specificity for routine screening; tTG-IgG is particularly helpful when IgA deficiency makes IgA-based testing unreliable. Anti-nuclear antibodies are not specific to celiac disease. Deamidated gliadin peptide antibodies can be used, especially if IgA deficiency is present, but IgG-only DGP testing is less preferred as a sole screen. A celiac disease DNA test looks at genetic predisposition, not autoantibodies. Therefore, the serology that looks for autoantibodies in celiac disease is EMA-IgA and tTG-IgA/tTG-IgG.