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HelpTest 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.
Specimen Required
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 2 mL
Collection Instructions: Centrifuge and aliquot serum into a plastic vial.
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
Method Name
Indirect Immunofluorescence Assay (IFA)
Reporting Name
Endomysial Abs (IgG), SSpecimen Type
SerumSpecimen 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 |
Reject Due To
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| Gross icterus | Reject |
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.
Interpretation
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.
Cautions
A negative result (absence of circulating IgG-endomysial antibodies) does not exclude the diagnosis of dermatitis herpetiformis or celiac disease.
Patients with mild gluten-sensitive enteropathy may have a negative result.
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;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;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;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;10(10):e038994. doi:10.1136/bmjopen-2020-038994
Method Description
Frozen sections of primate esophagus substrate are overlaid with dilutions of patient's serum, incubated, covered with fluorescein-conjugated IgG antiserum, and interpreted with a fluorescence microscope.(Package insert: NOVA Lite Monkey Oesophagus IFA Kit/Slides. Inova Diagnostics; 05/2018)
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-screen
86231-titer (if appropriate)
NY State Approved
YesDay(s) Performed
Monday through Friday
Report Available
2 to 7 daysForms
If not ordering electronically, complete, print, and send a Gastroenterology and Hepatology Test Request (T728) with the specimen.