Serological Markers and/or Intestinal Biopsies in the Case-finding of Celiac Disease

Abstract

The new 2012 ESPGHAN guidelines for the pediatric diagnosis of celiac disease (CD) unraveled and stimulated an old/new discussion on the most efficient case-finding in pediatric CD. The fine balance between reliable serological markers and the gold diagnostic standard of small bowel histology is somewhat better understood. Due to a low diagnostic rate, changes in phenotype, increased incidence, epidemiological shifts, importance of early implementation of gluten free diet to prevent complications, the case-finding of CD should be improved. Our adult gastrointestinal colleagues did not adopt ESPGHAN diagnostic criteria and within the pediatric gastroenterology community, controversies exist. The present editorial on pediatric CD complements an adult CD one. It expands on the drawbacks, limitations and criticisms of the guidelines and calls for prudency, further research and follow-up studies. Until recent observations are implemented in the future guidelines, small bowel histology should remain the gold standard for case-finding in CD.

Gluten, Transglutaminase, Celiac Disease and IgA Nephropathy

“…Several well established serological markers are available for screening, diagnosing and follow-up: anti endomysium, antideamidated gliadin and anti tTg autoantibodies. However, two novel ones, the anti-neo-epitope tTg and anti-neo-epitope microbial Tg were recently described with good performances [11][12][13].…”

Outside of Normal Limits: False Positive/Negative Anti TG2 Autoantibodies

“…8.The debate whether to use only IgA-TG2 or to com bine a complementary diagnostic autoantibody, to improve diagnosis and follow-up performance, is as yet unresolved [2,5,12,21].…”

“…It seems that the currently available serological biomarkers' performances, like EMA or DGP, are not sufficient to replace IgA-TG2 AB [27,28], but recent data indicates that the neo-epitope TG2 AB is a prime candidate in this race [8]. Still, a combination test may prove better [2,5,10,11,12].…”

“…In the past, an elevated AB level was regarded as the main indication for a subsequent biopsy. With the advance of serological biomarkers and amelioration of their diagnostic reliability, they became essential to achieve cost-effective case-finding in CD [1,2]. Accepted assay sensitivities are above 74 and 81 and specificities above 99 and 97, for anti endomysial (EmA) and anti tissue transglutaminase (tTg), antibodies, respectively [3].…”

Transglutaminase 2 and Anti Transglutaminase 2 Autoantibodies in Celiac Disease and Beyond: Anti- Transglutaminase 2 Autoantibodies: Friends or Enemies

“…Several specific autoantibodies were described in CD: Anti endomysial [2], anti deamidated gliadin [3], anti transglutaminase (TG2 OMIN number 190 196) [4,5] and anti neoepitope tissue transglutaminase (tTg) [6][7][8][9]. All of them are used clinically for the diagnosis of symptomatic or high risk patients and for screening of populations [10,11]. The present review will concentrate on the IgA-TG2 autoantibodies, which are most frequently used and recommended by ESPGAHN [12] and some other gastrointestinal societies interested in CD.…”