Antitissue transglutaminase antibody determination versus upper endoscopic biopsy diagnosis of paediatric celiac disease

Saginur, Michael; Al-Refaee, Fawaz; Spady, Donald W.; Girgis, Safwat; Huynh, Hien Q.; Prosser, Connie; Persad, Rabin; Turner, Justine

doi:10.1093/pch/18.5.246

Cited by 8 publications

(15 citation statements)

References 30 publications

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“…This was because in our experience it is common for families to reduce gluten intake following the first aTTG result. Asymptomatic patients were not excluded, as was the case in our published study [ 9 ], and the inclusion of asymptomatic patients is supported by recently published data [ 14 ]. SD required confirmation of at-risk HLA haplotypes for CD (DQ2, DQ8), performed using reverse Sequence Specific Oligonucleotide (rSSO) and fluorescence measured by Luminex software.…”

Section: Methodsmentioning

confidence: 89%

“…Patients were eligible to consent to SD if they met our modification of the ESPGHAN criteria, justified as follows: An aTTG level ≥ 200 U/mL was used as the cut-off for eligibility. This is based on our own research using the same local laboratory method (using EliA Celikey IgA tTG) [ 9 ]. ESPGHAN criteria use aTTG 10x the upper limit of normal (ULN), which would be ≥70 U/mL based on our laboratory normal value [ 5 ].…”

Section: Methodsmentioning

confidence: 99%

“…ESPGHAN criteria use aTTG 10x the upper limit of normal (ULN), which would be ≥70 U/mL based on our laboratory normal value [ 5 ]. However, in our experience this would have led to the misdiagnosis of 2 patients (2/115) [ 9 ]. Given that this was a pilot study, it was essential in our opinion to use the most conservative cut-off and we used 28x ULN based on the prior demonstrated specificity [ 9 ].…”

Section: Methodsmentioning

confidence: 99%

“…However, in our experience this would have led to the misdiagnosis of 2 patients (2/115) [ 9 ]. Given that this was a pilot study, it was essential in our opinion to use the most conservative cut-off and we used 28x ULN based on the prior demonstrated specificity [ 9 ]. ESPGHAN criteria call for a confirmatory test, recommending antiendomysial antibody (EMA), from a blood sample drawn at an occasion separate from the initial aTTG test to avoid false positive results, owing to mislabeling or other technical errors [ 5 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 4 more Smart Citations

A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease

Rajani

Huynh

Shirton

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

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Background. The European Society for Pediatric Gastroenterology, Hepatology and Nutrition endorses serological diagnosis (SD) for pediatric celiac disease (CD). The objective of this study was to pilot SD and to prospectively evaluate gastrointestinal permeability and mucosal inflammation at diagnosis and after one year on the gluten-free diet (GFD). We hypothesized that SD would be associated with similar short term outcomes as ED. Method. Children, 3–17 years of age, referred for possible CD were eligible for SD given aTTG level ≥200 U/mL, confirmed by repeat aTTG and HLA haplotypes. Gastrointestinal permeability, assessed using sugar probes, and inflammation, assessed using fecal calprotectin (FC), at baseline and after one year on a GFD were compared to patients who had ED. Results. Enrolled SD (n = 40) and ED (n = 48) patients had similar demographics. ED and SD groups were not different in baseline lactulose: mannitol ratio (L : M) (0.049 versus 0.034; p = 0.07), fractional excretion of sucrose (%FES; 0.086 versus 0.092; p = 0.44), or fecal calprotectin (FC; 89.6 versus 51.4; p = 0.05). At follow-up, urine permeability improved and was similar between groups, L : M (0.022 versus 0.025; p = 0.55) and %FES (0.040 versus 0.047; p = 0.87) (p > 0.05). FC improved but remained higher in the SD group (37.1 versus 15.9; p = 0.04). Conclusion. Patients on the GFD showed improved intestinal permeability and mucosal inflammation regardless of diagnostic strategy. This prospective study supports that children diagnosed by SD have resolving mucosal disease early after commencing a GFD.

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Section: Methodsmentioning

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease

Rajani

Huynh

Shirton

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

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Celiac disease: a clinical review

et al. 2017

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Celiac disease (CD) is an immune-mediated inflammatory enteropathy triggered by gluten exposure in genetically susceptible individuals. It has a high prevalence approaching 1% of the US population. A high index of suspicion is warranted to diagnose CD as frequently patients present with extraintestinal or atypical manifestations. CD is diagnosed by a combination of serum serologies and duodenal biopsies. The majority of patients will respond to a lifelong gluten-free diet which is the cornerstone of therapy. Complications such as refractory CD, ulcerative jejunoileitis, enteropathy associated T-cell lymphoma and small bowel adenocarcinoma occur in a minority of patients.

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Tissue Transglutaminase Levels Are Not Sufficient to Diagnose Celiac Disease in North America Without Intestinal Biopsies: Don’t Throw the Baby Out with the Bathwater

Turner

Huynh

2017

Dig Dis Sci

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Antitissue transglutaminase antibody determination versus upper endoscopic biopsy diagnosis of paediatric celiac disease

Cited by 8 publications

References 30 publications

A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease

A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease

Celiac disease: a clinical review

Tissue Transglutaminase Levels Are Not Sufficient to Diagnose Celiac Disease in North America Without Intestinal Biopsies: Don’t Throw the Baby Out with the Bathwater

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