Undetectable negative tissue transglutaminase IgA antibodies predict mucosal healing in treated coeliac disease patients

Abstract

In subjects recovering from coeliac disease with negative tTG IgA serology, an undetectable titre is associated with normal histology on follow-up biopsy.

Prospective longitudinal study: use of faecal gluten immunogenic peptides to monitor children diagnosed with coeliac disease during transition to a gluten‐free diet

“…Our findings also help to clarify the interpretation of coeliac serology tests after a diagnosis of coeliac disease is established. Although widely used to monitor patients on a GFD and highly specific for persistent villous atrophy on a GFD, the low sensitivity of serum tTG, EMA and DGP antibodies tests renders a negative test substantially less informative . We found that those with detectable levels of GIP in stool had a more prolonged elevation and a more gradual fall in tTG antibody than those whose stools tested negative.…”

Editorial: a novel approach to monitor mucosal healing in coeliac disease—as simple as shifting goalposts? Authors’ reply

“…1,2 We agree that the optimal noninvasive method for the assessment of mucosal healing in coeliac disease patients is still yet to be found. Although tTG-IgA serology remains sensitive for diagnoses of active disease, 3,4 it has been well shown that they are poor makers to detect persistent villous atrophy.…”

“…However, when looking for evidence of persistent mucosal atrophy in long-term treated coeliac disease patients, we have shown that 77% of patients with undetectable serology had no evidence of persistent villous atrophy. 2 Though not quite reaching statistical significance, there was a trend towards the absence of symptoms being a …”

“…Although tTG-IgA serology remains sensitive for diagnoses of active disease, 3,4 it has been well shown that they are poor makers to detect persistent villous atrophy. [5][6][7][8] In our study, 2 we assessed the utility of lowering the "abnormal"…”

Editorial: a novel approach to monitor mucosal healing in coeliac disease—as simple as shifting goalposts?

“…In a recent issue of AP&T , Fang et al. take a fresh look at tTG IgA . The authors tested their clinical observation that a negative tTG IgA result (defined by their lab as < 4 U/mL) where the antibody titre was undetectable ( < 1.2 U/mL) was more likely to be associated with mucosal healing than a negative but detectable tTG IgA level (1.2‐3.9 U/mL).…”