Serologic Evaluation of Celiac Disease for Patients Younger Than 2 Years of Age

Mallon, Daniel; Hajjat, Temara

doi:10.1016/j.jpeds.2020.05.023

Cited by 1 publication

(2 citation statements)

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“…Serologic testing for the diagnosis of CD has evolved in the last few decades, and, currently, the recommended initial screening test for CD is TTG IgA [ 1 , 2 ]. However, despite the high sensitivity of TTG IgA in adults and older children, there has historically been hesitation about the application of this test in younger children under two years of age, as highlighted in a recent editorial on this issue [ 30 ]. Several studies using either anti-native gliadin antibodies or DGP IgG and TTG IgA antibodies suggested that TTG IgA performs less well in this age group [ 6 , 7 , 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…As the disease progresses, antibodies are eventually produced against both gliadin and TTG. Full expression of EMA and TTG antibodies generally occurs after 2–3 years of age [ 9 , 30 ]. Indeed, we also found, by the systematic review of longitudinal cohort studies, that DGP IgG often precedes TTG IgA seroconversion, suggesting that DGP IgG antibodies determination may allow earlier detection of CD.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic Accuracy of IgA Anti-Transglutaminase and IgG Anti-Deamidated Gliadin for Diagnosis of Celiac Disease in Children under Two Years of Age: A Systematic Review and Meta-Analysis

et al. 2021

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The need of adding the determination of anti-deamidated gliadin peptide (DGP) IgG to anti-transglutaminase (TTG) IgA antibodies for diagnosis of celiac disease (CD) in children <2 years of age is controversial. We performed a systematic review and meta-analysis to evaluate, by head-to-head comparison, the diagnostic accuracy of TTG IgA and DGP IgG antibodies. We searched PubMed, MEDLINE, and Embase databases up to January 2021. The diagnostic reference was intestinal biopsy. We calculated the sensitivity and specificity of these tests and the odds ratio (OR) between the tests. Fifteen articles were eligible for the systematic review and ten were eligible for the meta-analysis. Sensitivity and specificity were 0.96 (95% confidence interval (CI), 0.91–0.98) and 0.96 (95% CI, 0.85–0.99) for DGP IgG and 0.93 (95% CI, 0.88–0.97) and 0.98 (95% CI, 0.96–0.99) for TTG IgA, respectively. TTG IgA specificity was significantly higher (OR 9.3 (95% CI, 2.3–37.49); p < 0.001) while the sensitivity of DGP IgG was higher without reaching statistical significance (OR: 0.6 (95% CI, 0.24–1.51); p = 0.28). Both the meta-analysis and the systematic review showed that some children with early CD are missed without the DGP IgG test. In children <2 years of age, TTG IgA is the best CD screening test; however, the addition of DGP IgG may increase the diagnostic sensitivity.

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