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Difficulty: EasyGastroenterology and Hepatology

A fundamental step in the evaluation of suspected autoimmune and inflammatory conditions of the gastrointestinal tract and liver is the identification of specific autoantibodies. Match each of the following clinical diagnoses with its most characteristic serologic marker.

  • Primary biliary cholangitisAnti-mitochondrial antibody
  • Primary sclerosing cholangitisPerinuclear anti-neutrophil cytoplasmic antibody (p-ANCA)
  • Autoimmune hepatitis (Type 1)Anti-smooth muscle antibody
  • Celiac diseaseAnti-tissue transglutaminase IgA

Answer

Primary biliary cholangitis matches with Anti-mitochondrial antibody; Primary sclerosing cholangitis matches with p-ANCA; Autoimmune hepatitis (Type 1) matches with Anti-smooth muscle antibody; Celiac disease matches with Anti-tissue transglutaminase IgA.
Accurate diagnosis of autoimmune gastrointestinal and liver conditions relies heavily on specific serologic profiles. Anti-mitochondrial antibody is the hallmark of primary biliary cholangitis. p-ANCA is frequently positive in primary sclerosing cholangitis, which is closely linked to inflammatory bowel disease. Anti-smooth muscle antibody is characteristic of autoimmune hepatitis type 1. Finally, anti-tissue transglutaminase IgA is the most accurate initial test for celiac disease.

Step-by-Step Solution

1
Identify the characteristic autoantibody for primary biliary cholangitis.
Anti-mitochondrial antibody (AMA).
AMA is the hallmark serologic marker for diagnosing primary biliary cholangitis, an autoimmune destruction of small intrahepatic bile ducts.
2
Identify the characteristic autoantibody for primary sclerosing cholangitis.
Perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA).
While not entirely specific, p-ANCA is found in the majority of patients with primary sclerosing cholangitis, reflecting its strong association with inflammatory bowel disease.
3
Identify the characteristic autoantibody for autoimmune hepatitis (Type 1).
Anti-smooth muscle antibody.
Type 1 autoimmune hepatitis typically presents with positive anti-smooth muscle antibodies and/or anti-nuclear antibodies.
4
Identify the characteristic autoantibody for celiac disease.
Anti-tissue transglutaminase IgA.
Anti-tissue transglutaminase IgA is the most sensitive and specific initial screening test for celiac disease.

Key Concept

Autoantibodies in gastrointestinal and hepatobiliary diseases
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Topics

Gastroenterology and Hepatology

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