Evaluation of the ESPGHAN Celiac Guidelines in a North American Pediatric Population

Gidrewicz, Dominica; Potter, Kathryn; Trevenen, Cynthia; Lyon, Martha E.; Butzner, J. Decker

doi:10.1038/ajg.2015.87

Cited by 70 publications

(75 citation statements)

References 21 publications

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“…Following the 2012 ESPGHAN guideline, studies were done to assess validity of the guideline. Gidrewicz et al showed that 98% of symptomatic pediatric patients with anti-tTG ≥ 10 times ULN and positive EMA had biopsies consistent with celiac disease [38]. Our study similarly showed that anti-tTG equal to or more than 10 times ULN was significantly correlated with histopathological changes of CD as 94% of our patients with anti-tTG ≥ 10 times ULN had histological evidence of CD.…”

Section: Discussionsupporting

confidence: 81%

Association of Tissue Transglutaminase Antibody Titer with Duodenal Histological Changes in Children with Celiac Disease

Hawamdeh

Al-Zoubi

Sharqi

et al. 2016

Gastroenterology Research and Practice

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Celiac disease is usually diagnosed by demonstrating gluten enteropathy in small bowel biopsy. Celiac specific antibodies are used as an initial screening test. The goal of this study is to test the relationship of the anti-tTG titer and severity of histological changes in Jordanian children with celiac disease. Method. The medical records of 81 children who had elevated anti-tTG titer and had duodenal biopsies available were retrospectively reviewed. Result. Assessing the association of anti-tTG titer with duodenal histopathological changes, 94% of those with high anti-tTG titer (≥180 U/mL) had histological evidence of celiac disease. There was statistically significant positive association between high anti-tTG titer and Marsh grading as 82% of patients with Marsh III had high anti-tTG titer (Chi2 18.5; P value 0.00; Odds Ratio 8.5). The fraction of patients with Marsh III who were correctly identified as positive by anti-tTG titer ≥ 180 U/mL was high (sensitivity = 81.6). Moreover, the fraction of patients with anti-tTG titer ≥ 180 U/mL who had Marsh III was also high (positive predictive value = 78.4). Conclusion. Anti-tTG titer ≥ 180 U/mL had significant positive association with Marsh III histopathological changes of celiac disease.

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Section: Discussionsupporting

confidence: 81%

Association of Tissue Transglutaminase Antibody Titer with Duodenal Histological Changes in Children with Celiac Disease

Hawamdeh

Al-Zoubi

Sharqi

et al. 2016

Gastroenterology Research and Practice

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“…Altogether 33% of new coeliac disease patients could have been diagnosed applying the “triple criteria”, which might be even a conservative estimation as some subjects with a high likelihood for coeliac disease withdrew before the endoscopy. In the population‐based low‐risk cohort, the figure (48%) was close to that seen in paediatric studies . Besides being easier for patients, reduced endoscopies could provide substantial healthcare savings, as it is estimated that up to 95% of diagnostic expenses could be spared by omitting the biopsy .…”

Section: Discussionsupporting

confidence: 63%

Serology‐based criteria for adult coeliac disease have excellent accuracy across the range of pre‐test probabilities

Fuchs

Kurppa

Huhtala

et al. 2018

Aliment Pharmacol Ther

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Summary Background The revised paediatric criteria for coeliac disease allow omission of duodenal biopsies in symptomatic children who have specific serology and coeliac disease‐associated genetics. It remains unclear whether this approach is also applicable for adults with various clinical presentations. Aim To evaluate the accuracy of serology‐based criteria in adults with variable pre‐test probabilities for coeliac disease. Methods Three study cohorts comprised adults with high‐risk clinical coeliac disease suspicion (n = 421), moderate‐risk family members of coeliac disease patients (n = 2357), and low‐risk subjects from the general population (n = 2722). Serological and clinical data were collected, and “triple criteria” for coeliac disease comprised transglutaminase 2 antibodies >10× the upper limit of normal, positive endomysium antibodies, and appropriate genetics without requirement of symptoms. The diagnosis was based on intestinal biopsy. Results The diagnosis of coeliac disease was established in 274 subjects. Of these, 59 high‐risk subjects, 17 moderate‐risk subjects, and 14 low‐risk subjects fulfilled the “triple criteria”. All had histologically proven coeliac disease, giving the criteria a positive predictive value of 100%. Altogether, 90 (33%) of all 274 newly diagnosed patients could have avoided biopsy, including 37% among high‐risk, 20% among moderate‐risk, and 48% among low‐risk patients. No histological findings other than coeliac disease were found in the biopsies of “triple positive” subjects. Conclusions Coeliac disease can reliably and safely be diagnosed without biopsy in adults fulfilling the “triple criteria” regardless of the pre‐test probability. Revised criteria would enable the number of endoscopies to be reduced by one‐third.

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“…Multiple pediatric studies demonstrate strong correlation between TTG and/or antibody to deamidated gliaden peptide (DGP) levels and duodenal histology (9–14). Given the effects of cost on payers with United States (US) health care reform changes, we sought to determine the most accurate diagnostic tests, which would limit unnecessary testing and costs.…”

Section: Introductionmentioning

confidence: 99%

Identification of Pediatric Patients With Celiac Disease Based on Serology and a Classification and Regression Tree Analysis

Ermarth

Bryce

Woodward

et al. 2017

Clinical Gastroenterology and Hepatology

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Background & Aims Celiac disease is detected using serology and endoscopy analyses. We used multiple statistical analyses of a geographically isolated population in the United States to determine whether a single serum screening can identify individuals with celiac disease. Methods We performed a retrospective study of 3555 pediatric patients (18 years old or younger) in the intermountain West region of the United States from January 1, 2008 through September 30, 2013. All patients had undergone serologic analyses for celiac disease, including measurement of antibodies to tissue transglutaminase (TTG) and/or deamidated gliadin peptide (DGP), and had duodenal biopsies collected within the following year. Modified Marsh criteria were used to identify patients with celiac disease. We developed models to identify patients with celiac disease using logistic regression and classification and regression tree (CART) analysis. Results Single use of a test for serum level of immunoglobulin A (IgA) against TTG identified patients with celiac disease with 90% sensitivity, 90% specificity, a 61% positive-predictive value (PPV), a 90% negative-predictive value, and an area under the receiver operating characteristic curve value of 0.91; these values were higher than those obtained from assays for IgA against DGP or IgG against TTG plus DGP. Not including the test for DGP antibody caused only 0.18% of celiac disease cases to be missed. Level of TTG IgA 7-fold the upper limit of normal (ULN) identified patients with celiac disease with a 96% PPV and 100% specificity. Using CART analysis, we found a level of TTG IgA 3.2-fold the ULN and above to most accurately identify patients with celiac disease (PPV of 89%). Multivariable CART analysis showed that a level of TTG IgA 2.5-fold the ULN and above was sufficient to identify celiac disease in patients with type 1 diabetes (PPV of 88%). Serum level of IgA against TTG in patients with vs those without trisomy 21 did not affect diagnosis predictability in CART analysis. Conclusion In a population-based study, we found that serum level of IgA against TTG can identify patients with celiac disease with PPVs of about 90%. Predictive values increase greatly when levels are markedly above the ULN or when the assay is used in combination with other variables. Measurement of IgG against TTG or DGP does not increase the accuracy of detection of celiac disease based against TTG IgA levels. There is a low risk of false-positive results from serologic analysis in patients with type I diabetes or persistent increases in antibody against TTG on repeat testing.

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Evaluation of the ESPGHAN Celiac Guidelines in a North American Pediatric Population

Abstract: The TTG is a very sensitive screen for CD, but positive predictive value improves with a positive EMA titer. To apply the new ESPGHAN guidelines, clinicians must understand the performance of their celiac serology tests.

Cited by 70 publications

References 21 publications

Association of Tissue Transglutaminase Antibody Titer with Duodenal Histological Changes in Children with Celiac Disease

Association of Tissue Transglutaminase Antibody Titer with Duodenal Histological Changes in Children with Celiac Disease

Serology‐based criteria for adult coeliac disease have excellent accuracy across the range of pre‐test probabilities

Identification of Pediatric Patients With Celiac Disease Based on Serology and a Classification and Regression Tree Analysis

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