Intestinal anti-tissue transglutaminase IgA deposits as a complementary method for the diagnostic evaluation of celiac disease in patients with low-grade histological lesions

Abstract

Summary Evaluating the usefulness of intestinal anti-transglutaminase IgA (anti-TG2 IgA) deposits detection as a complementary or decision-supporting tool in the diagnosis of celiac disease (CD) in patients with low degree of enteropathy. Small intestinal biopsies (SIB) were performed from 2008 to 2017 in patients on suspicion of CD (positive CD serology and/or symptoms) referred to our Pediatric Gastroenterology Unit. We determined anti-TG2 IgA deposits by using double immunofluorescence in all the patients in whom Marsh 0 or Marsh1 was detected in the conventional histological study and in a random selection of patients with clearly positive serology and histological Marsh 2-3 lesion. 75 pediatric patients were split into 3 groups according to the final diagnosis: 1) 13 children with a Marsh 0 or 1, negative CD serology and final non-CD diagnosis;none presented intestinal anti-TG2 IgA deposits; 2) 15 potential CD cases (Marsh 0 or 1 and CD-associated antibodies), detecting anti-TG2 IgA deposits in 12; on follow-up, another biopsy performed in 11/15 showed villi atrophy in 7 and a Marsh 2 lesion in two of them, patients being finally diagnosed as CD cases; and 3) 47 children with Marsh 2-3 histological lesion and final CD diagnosis; all of them had intestinal anti-TG2 IgA deposits. Anti-TG2 deposits are a useful complementary tool for CD diagnosis in pediatric population with digestive pathologies suggestive of CD. It is especially helpful in those with low grade lesion, in which anti-TG2 deposits are predictive of the development of more severe lesions on follow-up.

Skin gluten-related disorders: new and old cutaneous manifestations to be considered

“…In children with anti-TG-2 positivity lower than 10 times the upper limit, at least 4 biopsies from the distal duodenum and at least 1 from the bulb should however be taken ( 19 ). Recently, Roca et al ( 22 ) suggested the detection intestinal anti-TG2 deposits as a complementary or supporting tool for CD diagnosis in pediatric population with symptoms suggestive of CD and low-grade histological picture.…”

Type 2 Transglutaminase in Coeliac Disease: A Key Player in Pathogenesis, Diagnosis and Therapy

“…Since anti-TG2 antibodies are produced at the intestinal mucosa level and only later spill off in blood vessels, methods to detect them in situ could have a diagnostic utility in situations of doubt (for example, in patients with negative serology) or when other approaches are inconclusive [ 105 , 106 ]. First detection of intestinal anti-TG2 antibodies is performed on faecal supernatants.…”