Value of IgA tTG in Predicting Mucosal Recovery in Children With Celiac Disease on a Gluten‐Free Diet

Abstract

Objective Our objective was to determine the rate of mucosal recovery in pediatric patients with celiac disease on a gluten free diet. We also sought to determine whether IgA tissue transglutaminase (tTG) correlates with mucosal damage at the time of a repeat endoscopy with duodenal biopsy in these patients. Methods We performed a retrospective chart review of one-hundred and three pediatric patients, under 21 years of age, with a diagnosis of celiac disease defined as Marsh 3 histology, and who underwent a repeat endoscopy with duodenal biopsy at least twelve months after initiating a gluten free diet. Results We found that 19% of pediatric patients treated with a gluten free diet had persistent enteropathy. At the time of the repeat biopsy, tTG was elevated in 43% of cases with persistent enteropathy and 32% of cases in which there was mucosal recovery. Overall the positive predictive value of the autoantibody tissue transglutaminase was 25% and the negative predictive value was 83% in patients on a gluten free diet for a median of 2.4 years. Conclusions Nearly one in five children with celiac disease in our population had persistent enteropathy despite maintaining a gluten free diet and IgA tTG was not an accurate marker of mucosal recovery. Neither the presence of symptoms nor positive serology were predictive of a patient’s histology at the time of repeat biopsy. These findings suggest a revisitation of monitoring and management criteria of celiac disease in childhood.

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

“…16 However, when monitoring patients in follow-up, tTG IgA titres were poor indicators of mucosal healing, with sensitivities reported between 41% and 60%. [6][7][8][9] Our work differs in that we looked at mucosal healing within a population with only negative follow-up tTG IgA titres. Due to the limitation of the serology kit used, our data were analysed categorically, and as such we were unable to identify an ideal cut-off limit.…”

“…3 While a persistently positive tTG test is predictive of ongoing damage in the intestine and likely gluten contamination, a negative tTG test has quite variable sensitivity for intestinal healing. [4][5][6][7][8][9] Several different immunoassay kits exist to detect tTG antibodies, however, the sensitivity and cut-off for normal values can be kit-dependent. 10 At our facility, the assay used has the following tTG IgA reference values: <4 U/mL (negative); 4-10 U/mL (weak positive); and >10 U/mL (positive).…”

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

“…Specifically, research shows that 25%‐40% of adults with coeliac disease have persistent enteropathy after 2 years on a GFD . Children are thought to recover more quickly, and data suggests that 5%‐19% of coeliac children on a GFD may have persistent enteropathy despite treatment with a GFD for at least 1 year . Moreover, while the experts agree strict adherence to the GFD is crucial for the health of coeliac patients, there are no evidence‐based recommendations regarding the most efficient way to assess GFD adherence .…”

Multi-omics analysis reveals the influence of genetic and environmental risk factors on developing gut microbiota in infants at risk of celiac disease

“…Notably, CD is the only autoimmune disorder for which the environmental trigger is known [3] (exposure to gluten). Given that the timing of exposure to gluten and the dose of gluten ingested can be carefully monitored, and since gluten removal results in the resolution of symptoms and enteropathy for most patients [4][5][6][7][8], CD can serve as a tunable model of chronic immune-based disorders [9]. This allows for insights into its pathogenesis to be applied not only to individuals with CD but those with other autoimmune diseases as well.…”