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What is Anti-endomysial Antibody (EMA) test?

Anti-endomysial antibodies are a type of autoantibodies - antibodies that attack healthy cells instead of pathogens - found in people with celiac disease. These antibodies mainly attack the inner lining of the intestines, causing irritation and swelling.  

Celiac is an autoimmune disorder, in which, a person’s body starts to respond abnormally to gluten - a protein found in foods such as wheat, barley and rye. Any time a celiac patient consumes gluten-rich foods, his/her body starts producing antibodies against itself. If left untreated, celiac disease can lead to complications like malabsorption of nutrients and growth stunting in children, increased risk of abortion and birth defects and intestinal cancer.

An EMA test is one of the most accurate diagnostic tests for celiac disease. Usually, it looks for IgA (immunoglobulin A) type antibodies in the bloodstream of an individual. This is because these antibodies are the most sensitive and can hence be easily detected. However, IgG EMA antibodies are tested if a person is IgA antibody-deficient.

EMA is also useful as a screening test when the probability of celiac disease is low, such as in individuals with diabetes mellitus.

If the EMA report is positive, a biopsy is done to confirm the results. 

  1. Why is an Anti-endomysial Antibody (EMA) test performed?
  2. How do you prepare for an Anti-endomysial Antibody (EMA) test?
  3. How is an Anti-endomysial Antibody (EMA) test performed?
  4. Anti-endomysial Antibody (EMA) test results and normal values

Why is an Anti-endomysial Antibody (EMA) test performed?

EMA test is done for early detection of coeliac disease.

Your doctors may order an EMA test if you show the following symptoms:

In children:

The test also helps in monitoring the effect of a gluten-free diet on the progress of the disease.

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How do you prepare for an Anti-endomysial Antibody (EMA) test?

Fasting is not necessary before the EMA test. Corticosteroids, drugs that alter the immune system (immunomodulation drugs) and a gluten-free diet can lead to error in the results. However, do not discontinue the use of gluten-containing food items for a minimum of four weeks before the test. Also, inform your doctor if you are taking any medicines before undergoing the test.

How is an Anti-endomysial Antibody (EMA) test performed?

A nurse will collect a blood sample from a vein in your arm using a syringe. He/she will store it in a red-top tube and send it to the laboratory for analysis. 

Excessive bleeding, infection, hematoma (collection of blood under the skin at the site of needle insertion) are few minor side effects that may occur after the test. Some people also tend to feel dizzy and lightheaded after the test.

Results will be available after around one to eight days after the test.

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Anti-endomysial Antibody (EMA) test results and normal values

Normal results: 

An antibody titre of less than 1:10 indicates negative for IgA anti-endomysial antibodies. Normal results are suggestive of the absence of coeliac disease.

Few factors such as age less than two years and deficiency of IgA lead to a false-negative result.

Abnormal results: 

Positive results for IgA anti-endomysial antibodies are considered abnormal.

Positive results in the EMA test indicate the following:

  • Coeliac disease
  • Dermatitis herpetiformis, an autoimmune disorder of skin associated with coeliac disease. It is characterised by the formation of itchy boils and blisters on the skin.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Chorzelski TP et al. IgA anti-endomysium antibody. A new immunological marker of dermatitis herpetiformis and coeliac disease. Br J Dermatol. 1984 Oct;111(4):395-402. PMID: 6435666
  2. National Institute of Diabetes and Digestive and Kidney Diseases [internet]: US Department of Health and Human Services; Celiac Disease Testing (for Health Care Professionals)
  3. Martin W James, Brian B Scott. Endomysial antibody in the diagnosis and management of coeliac disease. BMJ Volume 76, Issue 898. http://dx.doi.org/10.1136/pmj.76.898.466.
  4. Mohsin Rashid. Serologic testing in celiac disease: Practical guide for clinicians. Can Fam Physician. 2016 Jan; 62(1): 38–43. PMID: 26796833
  5. Posner EB, Haseeb M. Celiac Disease. [Updated 2018 Dec 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan
  6. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; Endomysial Antibody
  7. Laboratory Procedure Manual: Center for Disease Control and Prevention [internet], Atlanta (GA): US Department of Health and Human Services; Endomysial Antibody Assay (EMA)
  8. University of Iowa. Department of Pathology. Laboratory Services Handbook [internet]. Endomysial Antibody, IgG
  9. National Institute of Diabetes and Digestive and Kidney Diseases [internet]: US Department of Health and Human Services; Dermatitis Herpetiformis (For Health Care Professionals)
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