Endomysial Antibody (IgA)

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Detects antibodies to endomysium.

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Endomysial Antibody (IgA) Test Information Guide

Why is it done?
- Detects IgA antibodies against endomysium (tissue protein in muscle), which are markers of celiac disease and dermatitis herpetiformis
- Confirms diagnosis of celiac disease in patients with positive tissue transglutaminase (tTG) serology
- Screens patients presenting with gastrointestinal symptoms including chronic diarrhea, malabsorption, abdominal pain, and bloating
- Evaluates patients with dermatitis herpetiformis, a skin manifestation of gluten sensitivity
- Identifies patients with family history of celiac disease or autoimmune conditions
- Monitors compliance with gluten-free diet in diagnosed celiac patients
- Typically performed before small intestinal biopsy to increase diagnostic certainty
Normal Range
- Normal Result: Negative or <1.0 U/mL (units may vary by laboratory)
- Abnormal Result: Positive or >1.0 U/mL
- Units of Measurement: U/mL (units per milliliter) or qualitative (negative/positive)
- Negative Result: Indicates absence of IgA antibodies to endomysium, making celiac disease unlikely in most cases; however, does not completely exclude celiac disease
- Positive Result: Suggests celiac disease or dermatitis herpetiformis; requires confirmation with additional testing (endoscopy with small bowel biopsy)
- High Positive Result: Indicates higher likelihood of active celiac disease and continued gluten exposure
Interpretation
- Positive EMA-IgA with Positive tTG-IgA: High specificity (>95%) for celiac disease; confirms diagnosis and warrants endoscopic biopsy for confirmation
- Positive EMA-IgA with Negative tTG-IgA: Rare occurrence; may indicate early celiac disease or dermatitis herpetiformis
- Negative EMA-IgA with Positive tTG-IgA: Occurs in approximately 10-20% of tTG-positive cases; may indicate early disease or weak antibody response
- Negative EMA-IgA with Negative tTG-IgA: Celiac disease unlikely; consider alternative diagnoses for presenting symptoms
- Quantitative Values: Higher IgA antibody titers generally correlate with more severe intestinal damage and greater adherence to gluten-containing diet
- Factors Affecting Results:
- • Ongoing gluten consumption (increases antibody levels) • Duration of gluten-free diet (decreases antibody levels over time) • IgA deficiency (false negative results possible; total IgA should be measured) • Concurrent medications affecting immune response • Disease severity and extent of intestinal damage • Individual immune response variations
- Clinical Significance: EMA-IgA has superior specificity (approximately 95-100%) compared to tTG-IgA and is considered the gold standard confirmatory test for celiac disease; remains positive in active disease and normalizes with adherence to gluten-free diet
Associated Organs
- Primary Organ System: Gastrointestinal tract, particularly the small intestine (duodenum and jejunum)
- Secondary Organ Involvement: Skin (in dermatitis herpetiformis), nervous system, bones, reproductive organs
- Celiac Disease: Autoimmune condition causing villous atrophy and malabsorption in response to gluten ingestion; positive EMA-IgA indicates active small intestinal inflammation
- Dermatitis Herpetiformis: Skin manifestation of gluten sensitivity with characteristic blistering rash; approximately 75-90% of DH patients test positive for EMA-IgA
- Associated Complications:
- • Malnutrition and micronutrient deficiencies (iron, B12, folate, calcium) • Secondary lactose intolerance • Osteoporosis and increased fracture risk • Anemia (iron-deficiency or megaloblastic) • Infertility and miscarriage • Dermatitis herpetiformis (pruritic skin condition) • Associated autoimmune diseases (thyroid disease, type 1 diabetes, lupus) • Increased risk of gastrointestinal lymphoma if untreated • Refractory celiac disease (treatment-resistant) • Neurological complications (ataxia, peripheral neuropathy, epilepsy)
Follow-up Tests
- Confirmatory Diagnostic Tests (if Positive):
- • Upper endoscopy with small intestinal biopsy (duodenal and jejunal samples) - gold standard for diagnosis • Histological examination for villous atrophy (Marsh classification) • Total serum IgA (to rule out IgA deficiency affecting test accuracy)
- Complementary Serological Tests:
- • Tissue transglutaminase (tTG-IgA) - often run concurrently • Anti-deamidated gliadin peptide (DGP-IgA and DGP-IgG) • Anti-endomysial antibody (EMA-IgG) - for IgA-deficient patients
- Micronutrient Assessment (for confirmed celiac disease):
- • Complete blood count (CBC) - assess for anemia • Iron studies (serum ferritin, iron, TIBC) • Vitamin B12 and folate levels • Tissue transglutaminase (tTG-IgA and tTG-IgG) • Calcium and vitamin D levels • Prothrombin time (PT) - vitamin K status
- Screening for Associated Autoimmune Conditions:
- • Thyroid function tests (TSH, free T4) • Thyroid peroxidase (TPO) and thyroglobulin antibodies • Tissue transglutaminase (tTG-IgA) - concurrent autoimmunity • Fasting glucose or HbA1c (type 1 diabetes screening)
- Bone Health Assessment:
- • Dual-energy X-ray absorptiometry (DEXA) scan for osteoporosis screening • Alkaline phosphatase and bone-specific alkaline phosphatase
- Monitoring and Follow-up Schedule:
- • Repeat EMA-IgA at 6-12 months to assess dietary compliance and response to gluten-free diet (should normalize if diet adhered) • Annual or biennial celiac serology if maintaining strict gluten-free diet • Repeat endoscopy at 1-2 years to confirm mucosal healing • Ongoing monitoring for associated complications • Additional screening based on symptoms or suspected dietary lapses
Fasting Required?
- Fasting Required: No
- Fasting is not required for EMA-IgA testing. The test can be performed at any time of day without regard to meals or food intake.
- Patient Preparation Requirements:
- • Continue normal diet including gluten-containing foods for at least 6 weeks before testing to ensure antibodies are present (if diagnosing new celiac disease) • Avoid dietary changes immediately before testing • No special clothing restrictions; comfortable, loose-fitting sleeves recommended for blood draw • Arrive for appointment well-hydrated to facilitate venipuncture
- Medications - No Special Restrictions:
- • Continue all regularly prescribed medications as scheduled • Immunosuppressive drugs or corticosteroids may suppress antibody production; inform physician if taking these medications • No medications need to be held before test
- Important Considerations:
- • If patient has already started a gluten-free diet, inform the ordering physician as antibodies will be diminished or absent • For diagnostic purposes, testing should occur while patient is on regular gluten-containing diet • For compliance monitoring, any level of antibody positivity may indicate dietary lapses or cross-contamination • Simple blood draw procedure requiring only a few milliliters of serum • Results typically available within 5-7 business days

How our test process works!