Can Tissue Transglutaminase Antibody Titers Replace Small-Bowel Biopsy to Diagnose Celiac Disease in Select Pediatric Populations?

Barker, Colin; Mitton, Craig; Jevon, Gareth; Mock, Thomas

doi:10.1542/peds.2004-1392

Cited by 133 publications

(121 citation statements)

References 24 publications

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“…We confirm, however, that AAA positivity is associated with severe intestinal damage, as reported by other researchers (41)(42)(43)(44). Therefore, in the follow-up of pediatric patients with CD (i.e., monitoring the adherence to gluten-free diet), the AAA test may provide important information about mucosal status without the use of an invasive procedure (64)(65)(66)(67)(68). Regarding the possible use of elevated anti-tTG IgA levels as markers of severe histological damage, we confirm the data obtained by Donaldson et al (48,49) and Hill and Holmes (52), showing that all patients with elevated anti-tTG IgA concentrations had Marsh 3 intestinal atrophy.…”

Section: Discussionsupporting

confidence: 89%

“…Indeed, AAA are detectable mainly in CD patients with Marsh 3 lesions and their presence can be considered a marker of intestinal atrophy. However, more recent studies have shown that antitTG IgA concentrations also correlate with histopathological findings in adult and pediatric CD patients (45)(46)(47)(48)(49)(50)(51). Subsequently, Hill and Holmes (52) have shown that a ratio )10 to the anti-tTG level and the cut-off value is a reliable marker for the presence of Marsh G2 lesions.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The old and new tests for celiac disease: which is the best test combination to diagnose celiac disease in pediatric patients?

Brusca

Carroccio²,

Tonutti³

et al. 2012

Clinical Chemistry and Laboratory Medicine

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Background: In the diagnosis of celiac disease (CD), serum assays for anti-endomysium (EMA) and anti-transglutaminase (anti-tTG) antibodies have excellent diagnostic accuracy. However, these assays are less sensitive in young pediatric patients. Recently, a new ELISA test using deamidated gliadin peptides (DGP) as antigen has proved to be very sensitive and specific even in pediatric patients. In addition, anti-actin IgA antibodies (AAA) is another test that can be used in CD patients because antibody concentrations correlate with the degree of villous atrophy. This study evaluated the clinical accuracy of anti-tTG, EMA, AGA, anti-DGP and AAA and the effectiveness of these in different combinations for diagnosing CD in a large cohort of pediatric patients. Methods: Sera of 150 children under 6 years of age were tested: 95 patients had a diagnosis of CD, while 55 patients who did not suffer from CD were used as controls. Anti-DGP IgA/IgG and AAA were assayed with ELISA kits, while anti-tTG IgA/IgG and AGA IgG/IgA were assayed using a quantitative fluoroimmunoassay. The EMA test was conducted by indirect immunofluorescence.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

The old and new tests for celiac disease: which is the best test combination to diagnose celiac disease in pediatric patients?

Brusca

Carroccio²,

Tonutti³

et al. 2012

Clinical Chemistry and Laboratory Medicine

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show abstract

“…[24][25][26] Moreover, scores on gastrointestinal symptoms correlate with tTGA levels in adult patients, 26 and young children with severe signs of malabsorption have significantly higher tTGA levels than older children presenting with nonspecific symptoms. 24 In our cohort, symptomatic children with CDA and CD had higher tTGA levels at seroconversion.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features of Celiac Disease: A Prospective Birth Cohort

et al. 2015

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To investigate clinical features of celiac disease (CD) and their association with risk factors for CD in a genetic risk birth cohort.METHODS: Children from 6 clinical centers in 4 countries positive for HLA-DR3-DQ2 or DR4-DQ8 were annually screened for tissue transglutaminase antibodies (tTGA) and assessed for symptoms by questionnaires. Associations of symptoms with anthropometrics, known risk factors for CD, tTGA levels, and mucosal lesions in those biopsied were examined.RESULTS: Of 6706 screened children, 914 developed persistent positive tTGA, 406 underwent biopsies, and 340 had CD. Compared with age-matched tTGA-negative children, those with persistent tTGA were more likely to have symptoms at 2 (34% vs 19%, P , .001) and 3 years of age (28% vs 19%, P = .009) but not at 4 years (27% vs 21%, NS). Z-scores for height, weight, and BMI did not differ between groups. In children with persistent tTGA, having $1 symptom was associated with family history of CD (odds ratio = 2.59, 95% confidence interval, 1.21-5.57) but not with age, gender, or HLA-DR3-DQ2 homozygosity. At seroconversion, tTGA levels were higher in symptomatic than asymptomatic children (P , .001), in those from CD families (P , .001), and in US participants (P , .001) but not associated with age, gender, or HLA genotype. tTGA levels correlated with severity of mucosal lesions both in symptomatic (r = 0.53, P , .001) and asymptomatic children (r = 0.22, P = .01).

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“…In fact, it was shown that a good correlation existed between intensity of the intestinal damage and levels of serum TTG 87 and that selecting patients with elevated titers of TTG could result in an extremely high positive predictive value, hence predicting the possibility of avoiding the intestinal biopsy. [88][89][90][91] In addition, great emphasis has been placed by investigators on the diagnostic dilemma for patients presenting only minor or no changes at histological analysis of duodenal mucosa. [92][93] Do these patients have CD or not?…”

Section: Anti-deamidated Gliadin Peptides (Dgp)mentioning

confidence: 99%

Diagnosis of Celiac Disease

Tavakkoli

Lebwohl

2013

Clinical Gastroenterology

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Can Tissue Transglutaminase Antibody Titers Replace Small-Bowel Biopsy to Diagnose Celiac Disease in Select Pediatric Populations?

Abstract: When the cutoff values were changed to >100 and <20 U and IgA levels were verified, the sensitivity and specificity were very high. Patients with mid-range TTG values (20-100 U) or values of <20 U with negative IgA status should continue to undergo biopsies for diagnosis of celiac disease.

Cited by 133 publications

References 24 publications

The old and new tests for celiac disease: which is the best test combination to diagnose celiac disease in pediatric patients?

The old and new tests for celiac disease: which is the best test combination to diagnose celiac disease in pediatric patients?

Clinical Features of Celiac Disease: A Prospective Birth Cohort

Diagnosis of Celiac Disease

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