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Test ID EMAIG Endomysial Antibodies, IgG, Serum

Ordering Guidance

Cascade testing is recommended for celiac disease. Cascade testing ensures that testing proceeds in an algorithmic fashion. The following cascade tests are available; select the appropriate one for your specific patient situation.

-For complete testing including human leukocyte antigen (HLA) DQ, order CDCOM / Celiac Disease Comprehensive Cascade, Serum and Whole Blood

-For complete testing excluding HLA DQ, order CDSP / Celiac Disease Serology Cascade, Serum

-For patients already adhering to a gluten-free diet, order CDGF / Celiac Disease Gluten-Free Cascade, Serum and Whole Blood


To order individual tests, see Celiac Disease Diagnostic Testing Algorithm in Special Instructions.

Specimen Required

Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 2 mL

Useful For

Analysis of IgG-endomysial antibodies for the diagnosis of dermatitis herpetiformis and celiac disease


Monitoring adherence to gluten-free diet in patients with dermatitis herpetiformis and celiac disease

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
EMAGT EMA Titer (IgG), S No No

Testing Algorithm

If the IgG-endomysial antibodies result is positive or indeterminate, then the antibody titer will be performed at an additional charge.


The following algorithms are available:

-Celiac Disease Comprehensive Cascade Test Algorithm

-Celiac Disease Diagnostic Testing Algorithm

-Celiac Disease Gluten-Free Cascade Test Algorithm

-Celiac Disease Routine Treatment Monitoring Algorithm

-Celiac Disease Serology Cascade Test Algorithm

Method Name

Indirect Immunofluorescence Assay (IFA)

Reporting Name

Endomysial Abs (IgG), S

Specimen Type


Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 14 days
  Frozen  30 days
  Ambient  14 days

Clinical Information

Circulating IgG endomysial antibodies are present in 70% to 80% of patients with dermatitis herpetiformis or celiac disease, and in nearly all such patients who have high grade gluten-sensitive enteropathy and are not adhering to a gluten-free diet.


Because of the high specificity of endomysial antibodies for celiac disease, the test may obviate the need for multiple small bowel biopsies to verify the diagnosis. This may be particularly advantageous in the pediatric population, including the evaluation of children with failure to thrive.

Reference Values

Negative in normal individuals; also negative in patients with either dermatitis herpetiformis or celiac disease while adhering to gluten-free diet.


The finding of IgG-endomysial antibodies (EMA) is highly specific for dermatitis herpetiformis or celiac disease.


The titer of IgG-EMA generally correlates with the severity of gluten-sensitive enteropathy.


If patients strictly adhere to a gluten-free diet, the titer of IgG-EMA should begin to decrease within 6 to 12 months of onset of dietary therapy.


Occasionally, the staining results cannot be reliably interpreted as positive or negative because of strong smooth muscle staining, weak EMA staining or other factors; in this case, the results will be recorded as "indeterminate." In this setting, further testing with measurement of TTGA / Tissue Transglutaminase Antibody, IgA, Serum and IGG / Immunoglobulin G (IgG), Serum levels are recommended.

Clinical Reference

1. Dahlbom I, Olsson M, Forooz NK, Sjoholm AG, Truedsson L, Hannson T: Immunoglobulin G (IgG) anti-tissue transglutaminase antibodies used as markers for IgA-deficient celiac disease patients. Clin Diagn Lab Immunol. 2005 Feb;12(2): 254-258. doi: 10.1128/CDLI.12.2.254-258.2005

2. Korponay-Szabo IR, Dahlbom I, Laurila K, et al: Elevation of IgG antibodies against tissue transglutaminase as a diagnostic tool for coeliac disease in selective IgA deficiency. Gut. 2003 Nov 52(11):1567-1571. doi: 10.1136/gut.52.11.1567

3. Kumar V, Jarzabek-Chorzelska M, Sulej J, Karnewska K, Farrell T, Jablonska S: Celiac disease and immunoglobulin A deficiency: How effective are the serological methods of diagnosis? Clin Diagn Lab Immunol. 2002 Nov;9(6):1295-1300. doi: 10.1128/CDLI.9.6.1295-1300.2002

4. Elwenspoek MMC, Jackson J, Dawson S, et al: Accuracy of potential diagnostic indicators for coeliac disease: a systematic review protocol. BMJ Open. 2020 Oct 5;10(10):e038994. doi: 10.1136/bmjopen-2020-038994

Test Classification

This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information


86231-titer (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
EMAIG Endomysial Abs (IgG), S 39554-1


Result ID Test Result Name Result LOINC Value
608880 Endomysial IgG Ab, S 39554-1

Day(s) Performed

Monday through Friday

Report Available

2 to 7 days


If not ordering electronically, complete, print, and send a Gastroenterology and Hepatology Client Test Request (T728) with the specimen.