The Usefulness of IgA/IgG DGP/tTG Screen Assay for Celiac Disease Detection among Symptomatic and at Risk Young Children

Abstract

Background: It has been postulated that IgA anti tissue-transglutaminase (tTG) and anti-endomisium (EMA) antibodies can be false negative in young children.ESPGHAN recommended for seronegative children younger than 2 years old with clinical suspicion of celiac disease to perform duodenal biopsies. Recent studies sugested that the combined assay for IgA/IgG deamidated gliadin peptides (DGP) and tTG can detect celiac disease among seronegative young children. Aim: To assess if the new combined assay with synthetic gliadin derived peptides IgA/IgG-DGP/tTG is useful to detect celiac disease in IgA tTG or EMA seronegative children younger than 2 years old. Methods: The authors screened a lot of children aged 6 months to 2 years old that associated characteristic symptoms/risk factors for gluten enteropathy. 368 children were tested for IgAtTG, EMA and IgA/IgG-tTG/DGP combined assay. All children had normal total IgA concentration and were consuming gluten at the time of enrolment. Children with at least one positive serologic test underwent intestinal biopsy, including seronegative infants, DQ2/DQ8 positive, with clinical suspicion of celiac disease that underwent the 2 biopsies protocol. Results: Celiac disease was diagnosed in 22 children based on histology. 19 children were positive for IgA tTG, 20 were positive for EMA and 21 tested positive for IgA/IgG-DGP/tTG. IgA tTG sensitivity was 86.3%, IgA EMA sensitivity was 91% and IgA/IgG-DGP/tTG sensitivity was 95.4% (p=0.002). Conclusions: The sensitivity of IgA/IgG DGP/tTG assay was significantly higher than that of IgAtTG in celiac patients younger than 2 years old.The better performance of this new combined test can avoid repeated intestinal biopsies in young children with high clinical suspicion of celiac disease but negative tTG/ EMA serology.

Diagnostics of Adult Forms of Celiac Disease: More Intensive Screening Improves Diagnosis

“…Our results provide confirmatory evidence of this finding, but also show that these serological changes provide strong evidence for the characteristic histopathological changes of untreated celiac disease. Recent evidence suggests that detection of all clinical forms of CD may be most effective with a combination of IgA tTG antibodies coupled with autoantibodies against deaminated gliadin (DGP) [17,18]. Specialized groups have also supported the value of serological screening in adult CD [19,20].…”

Towards Finding More Diagnostic Serological Markers in Celiac Disease: Can Deamidated Gliadin Peptide Antibodies Help to Our Babies?

“…Diagnosis of celiac disease was made according to intestinal biopsy findings. They found the sensitivity of combined IgA/IgG DGP/tTG screen assay (95.4 %) higher than both antitTGA (86.3%) and anti-EmA (91%) antibodies in this age group of children [12]. They concluded that better performance of this combined tests might preclude repeated intestinal biopsies in young symptomatic children who have negative tTG/EmA serology.…”

“…On the other hand, some studies demonstrated superior diagnostic value of anti-tTG to anti-DGP antibodies even in patients younger than 2 years-old [11]. In this first issue of the Journal, Oana et al [12] investigated the accuracy of these antibodies in symptomatic infants. They evaluated the diagnostic value of combined IgA/IgG DGP/tTG screen assay in anti-IgA tTG or anti-EmA negative children younger than 2 yearsold.…”

Chemiluminescent Immunoassay versus Enzyme Linked Immunosorbent Assays for IgA Anti-Tissue Transglutaminase Antibodies Assessment in Celiac Disease Children

“…Using different serologic tests permitted a better selection of cases for intestinal biopsy in celiac patients. In clinical practice, serological tests for CD are useful in identifying patients who require intestinal biopsy findings to diagnose this condition [2]. Serological screening for CD in a population with associated risk factors is now considered the most efficient strategy, taking into account cost-effectiveness.…”

“…Serological screening for CD in a population with associated risk factors is now considered the most efficient strategy, taking into account cost-effectiveness. The efficiency of this serological screening is to identify the cases with atypical or oligo-symptomatic forms of CD [2].…”