Transglutaminase IgA Antibodies in a Celiac Disease Mass Screening and the Role of HLA‐DQ Genotyping and Endomysial Antibodies in Sequential Testing

Sandström, Olof; Rosén, Anna; Lagerqvist, Carina; Carlsson, Annelie; Hernell, Olle; Högberg, Lotta; Ivarsson, Anneli

doi:10.1097/mpg.0b013e31829ef65d

Cited by 39 publications

(46 citation statements)

References 18 publications

(33 reference statements)

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“…The Swedish population is considered genetically homogenous with >50% prevalence of HLA risk genes 27. Consequently, geographical differences in CD risk are not fully explained by genetic clustering, suggesting the role of other environmental factors.…”

Section: Discussionmentioning

confidence: 99%

Season and region of birth as risk factors for coeliac disease a key to the aetiology?

et al. 2016

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BackgroundCoeliac disease (CD) incidence has increased in recent decades, characterised by variations according to sex, age at diagnosis, year of birth, month of birth and region of birth. Genetic susceptibility and exposure to gluten are the necessary factors in CD aetiology, although several environmental factors are considered.MethodsA nationwide prospective cohort longitudinal study was conducted consisting of 1 912 204 children aged 0–14.9 years born in Sweden from 1991 to 2009. A total of 6569 children were diagnosed with biopsy-verified CD from 47 paediatric departments. Using Cox regression, we examined the association between CD diagnosis and season of birth, region of birth and year of birth.ResultsOverall, CD risk was higher for children born during spring, summer and autumn as compared with children born during winter: adjusted HR for spring 1.08 (95% CI 1.01 to 1.16), summer 1.10 (95% CI 1.03 to 1.18) and autumn 1.10 (95% CI 1.02 to 1.18). Increased CD risk was highest if born in the south, followed by central Sweden when compared with children born in northern Sweden. Children diagnosed at <2 years had an increased CD risk if born in spring while those diagnosed at 2–14.9 years the risk was increased for summer and autumn births. The birth cohort of 1991–1996 had increased CD risk if born during spring, for the 1997–2002 birth cohort the risk increased for summer and autumn births, while for the birth cohort of 2003–2009 the risk was increased if born during autumn.ConclusionsSeason of birth and region of birth are independently and jointly associated with increased risk of developing CD during the first 15 years of life. Seasonal variation in infectious load is the likely explanation.

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Section: Discussionmentioning

confidence: 99%

Season and region of birth as risk factors for coeliac disease a key to the aetiology?

et al. 2016

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“…10 Despite the increasing numbers of positive diagnoses for coeliac disease, the condition is frequently unrecognized, possibly due to its variable clinical presentation and symptoms, 11,12 such that for every one child diagnosed with coeliac disease, there are seven who remain undiagnosed. [13][14][15] Coeliac disease can also affect extraintestinal organs. In fact, nongastrointestinal manifestations are now more common in children than before, possibly because of a greater awareness of symptom diversity.…”

Section: Coeliac Diseasementioning

confidence: 99%

Coeliac disease and gluten-related disorders in childhood

Vriezinga

Schweizer

Koning

et al. 2015

Nat Rev Gastroenterol Hepatol

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Gluten-related disorders such as coeliac disease, wheat allergy and noncoeliac gluten sensitivity are increasingly being diagnosed in children. Coeliac disease occurs frequently, affecting 1-3% of the Western population. The condition manifests at a very young age, more so in girls, and is related to the HLA genotype. Coeliac disease might be considered a public health problem and, as primary prevention is not possible, the debate on mass screening should be reopened. Wheat proteins, including gluten, are responsible for one of the most common food allergies in children: wheat allergy. Unlike coeliac disease and wheat allergy, noncoeliac gluten sensitivity is an unclear and controversial entity. These three gluten-related disorders are treated with a gluten-free diet. In coeliac disease, the diet should be strictly followed, whereas wheat allergy only requires wheat elimination and in noncoeliac gluten sensitivity occasional trials of gluten reintroduction can be done. A good diagnostic work-up is important for gluten-related disorders in childhood to avoid unnecessary restrictive diets in children. In this Review, we provide an overview of the pathogenesis, diagnosis and management of the most common gluten-related disorders in children.

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“…Similarly, Sandström et al [12] prospectively screened 7161 children in Sweden with tTG IgA, EMA, and HLA DQ2/DQ8 and diagnosed 153 children with CD on SBB. tTG values of ≥10 times ULN (50U/mL) with positive EMA and HLA-DQ2 or DQ8 had a PPV and specificity of 100%.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of children also had all coeliac serology performed concurrently (rather than sequentially), potentially increasing the risk of false positives. The higher specificities and positive predictive values seen in recent prospective studies [11,12] highlight the importance of prospective analysis; ensuring the correct subjects enrolled into the correct groups, have the correct tests, at the correct times, to get the most accurate results from the ESPGHAN guidelines.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Application of the European Society for Paediatric Gastroenterology Hepatology and Nutrition Guidelines for Diagnosis of Coeliac Disease in New Zealand Children

Miller

Day²

2016

IJCD

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In 2012 the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) published an updated guideline for the diagnosis of Coeliac disease, allowing symptomatic individuals with appropriate serology and HLA genotype to be diagnosed without a small bowel biopsy. This retrospective study aimed to assess the applicability of this guideline to children in New Zealand. Children less than 16 years of age investigated for coeliac disease with small bowel biopsy in Christchurch Hospital between January 2010 and December 2012 were identified. The results of those with tissue transglutaminase IgA (tTG) levels greater than 50 units (10 times upper limit of normal), positive endomysial antibodies and HLA DQ2/DQ8 were used to calculate sensitivity and specificity. Data from 160 children was available: 70 had biopsy-confirmed Coeliac disease, and 90 had negative biopsies. Limited data precluded application of the guidelines to all patients. Using only tTG data, levels above 50 units provided a sensitivity of 67% and a specificity of 92%. Specificity increased to 97% when limited EMA and HLA DQ2/DQ8 data was added. Despite limited data, applying the ESPGHAN guidelines in the Christchurch paediatric population over this period produced a high specificity (97%). Prospective studies are now required to confirm these findings.

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Transglutaminase IgA Antibodies in a Celiac Disease Mass Screening and the Role of HLA‐DQ Genotyping and Endomysial Antibodies in Sequential Testing

Abstract: tTG-IgA is a robust marker when used in CD mass screening and its performance can be enhanced by sequential testing for EMA or HLA-DQ genotyping.

Cited by 39 publications

References 18 publications

Season and region of birth as risk factors for coeliac disease a key to the aetiology?

Season and region of birth as risk factors for coeliac disease a key to the aetiology?

Coeliac disease and gluten-related disorders in childhood

A Retrospective Application of the European Society for Paediatric Gastroenterology Hepatology and Nutrition Guidelines for Diagnosis of Coeliac Disease in New Zealand Children

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