Endomysial Antibodies (EMA) Test

What is the EMA test?

EMA test is an investigative blood examination to locate the presence of certain antibodies, called Endomysial antibodies or EMA-IgA in the blood. The presence of these antibodies may be indicative of an autoimmune disease known as celiac disease or dermatitis herpetiformis (a gluten-sensitive condition which shows up on the skin).

The protein gluten, present in food products that contain rye, barley, and wheat does not get an appropriate response from the immune system, in those suffering celiac disease. The body begins to create antibodies called as endomysial antibodies. These antibodies cause harm, by triggering inflammation of the intestine.

In severe cases, especially where it has escaped timely detection, the lining of the small intestine is completely damaged. This leads to malabsorption of nutrients from the food and associated health conditions.

Immunoglobulin A or IgA is a common antibody that plays a pivotal role in the immune function of mucous membranes. Victims of celiac disease are deficient in IgA as compared to the general population. Total immunoglobulin A (IgA) and Anti-tissue Transglutaminase Antibody (tTG) are the two most important tests performed in the beginning to diagnose celiac disease.

The EMA-IgA test is an important marker for celiac disease, portraying a 99% accuracy rate. This test is expensive and involves a high degree of technical precision. It is used as an accompanying test along with the routine tTG-IgA test to confirm the diagnosis of celiac disease. This test implies that anyone with a high titer of EMA is sure to be a victim of celiac disease. However, the EMA test scores are much lower in sensitivity than the tTG-IgA test.

Why should I undergo this test?

Your healthcare provider may want to confirm any suspicion of celiac disease after evaluating some of your symptoms and state of health.

Some of the underlying symptoms of celiac disease are:
– Constipation
– Fatigue
– Pain in the bone and joins
– Anemia
– Prolonged diarrhea
– Mood swings
– Lack of energy
– Persistent pain in the stomach
– Mouth ulcers
– Seizures
– Loss of weight
– Bloating
– Foul-smelling stool
– Fatty excreta
– Persistent gastric problem
– Itchy skin rash

Will I need to undergo any more blood tests along with EMA?

Along with EMA, your doctor may order the following diagnostic tests to support the diagnosis:

– Evaluate blood cell count
– Test to locate Anti-tissue transglutaminase, or tTG, antibodies and Anti-deaminated gliadin peptides
– Ascertain Cholesterol levels
– Evaluate Thyroid function
– Assess immunoglobulin A (IgA) deficiency

How do I prepare for this test?

You should adhere to the following very strictly before the EMA blood test.

– Be on a diet that contains gluten for a month at the least before the test. It is better to get a diet chart to follow.

– Discuss your medical conditions as well as all the medicines, supplements, vitamins and herbs that you regularly consume.

How is the EMA blood test performed?

The EMA test is performed with a blood sample.  A blood sample is drawn from a vein in your arm. Some patients do complain of feeling a bit faint after a blood sample is drawn. The site of the needle prick may turn a bit sore but it settles down in an hour or so.

When can I expect the results of the EMA blood test?

It takes about a week to 10 days to process the result of this blood test.

What do my test results mean?

If the results of the EMA blood test are negative, it clearly means there were no EMA antibodies present in the blood. A result portraying the absence of endomysial antibodies does not, however, confirm the absence of dermatitis herpetiformis or celiac disease. Even those who have mild gluten-sensitive enteropathy could have a negative EMA test.

Circulating IgA endomysial antibodies are found in close to 70% to 80% of patients with dermatitis herpetiformis or celiac disease. In case the blood tests show a high level of IgA EMA and tTG antibodies, it could be an indicator of celiac disease. Your symptoms are analyzed along with the blood test result to make a diagnosis. Your response to a gluten-free diet and relief in symptoms could also mean that you are a victim of celiac disease.

The titer of IgA-EMA is indicative of the extent of gluten-sensitive enteropathy. The next step if you have the celiac disease could be a biopsy of your intestine to ascertain the extent of the disease.

IS EMA test performed on children and babies?

Usually, children who carry a risk of celiac disease undergo screening at age 3. It is necessary that a pediatric gastroenterologist examines your child who could be portraying symptoms of the celiac disease like persistent diarrhea.  If children below 3 undergo antibody tests, the results may not be accurate.

Ideally, children should have been consuming barley or wheat-containing food products for at least a year. This enables the body to show up an autoimmune response to gluten, which can be picked up by the blood tests.

For young children, another method is to perform a genetic test. Although genetic tests can not diagnose celiac disease; it can help ascertain the risks of autoimmune conditions by evaluating the genes. A genetic test has no restrictions on age.

Following symptoms in children may be indicative of the need for EMA antibody testing for celiac disease:

– Vomiting
– Stunted growth
– Irritable and moody behavior
– Pale fatty stools
– Malnourishment
– Loss of weight
– Dental problems

Doctors may also ask for children below 2 to be tested for the presence of anti-gliadin antibodies.

How common is celiac disease in India?

Statistics show that the prevalence of the Celiac disease in the United States is about 1 in 150 people. Surprisingly, most of the people who have the disease do not know they are suffering from it. This is attributed to the varying intensity of symptoms. In India, it has been estimated that close to 6-8 million people suffer from this disease.

Even though biopsy may show intestinal damage, patients with mild symptoms may not be aware of their condition. Also, some of the symptoms mask od celiac disease mask that of other conditions, therefore it may escape diagnosis or be delayed for several years.

Nearly 100%of celiac disease victims and 70% of dermatitis herpetiformis victims will portray the IgA class of anti-EMA antibodies in their blood.

A jejunal biopsy may be a method to assist the diagnosis of those who are tTG or EMA negative but show symptoms of celiac disease. Genetic testing does not help with the diagnosis of celiac disease, but it can assess if you have a genetic predisposition to the disease.

What is the price for an EMA blood test in India?

The price of EMA blood test in India is close to Rs. 1700. It may differ slightly based on the city and the type of lab facilities available.

What are some of the Dos and Don’ts for the EMA test?