Variability of anti-human transglutaminase testing in celiac disease across Mediterranean countries

Smarrazzo, Andrea; Magazzù, Giuseppe; Benhariz, M.; Tamara, Maria Legarda; Velmishi, Virtut; Roma, Elefhteria; Kansu, Aydan; Mičetić-Turk, Dušanka; Bravi, E.; Stellato, Pio; Arcidiaco, Carmela; Greco, Luigi

doi:10.3748/wjg.v23.i24.4437

Cited by 4 publications

(2 citation statements)

References 7 publications

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“…The different test kits cause a problem regarding standardization in the diagnosis [ 15 ]. In their multicenter study including seven Mediterranean countries and 1,974 patients and using eight different kits, Smarrazzo et al [ 16 ] found that a TGA level >1.25 ULN was quite reliable for measurements, and detected the PPV to be 96.1% in cases where the TGA level was >10 ULN. In another Italian study [ 17 ] involving 234 patients, the PPV was determined to be 97.66% in the diagnosis of TGA based on the ESPGHAN criteria (>10 ULN).…”

Section: Discussionmentioning

confidence: 99%

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A No-Biopsy Approach for the Diagnosis of Celiac Disease in Adults: Can It Be Real?

Baykan¹,

Cerrah²,

Çiftel³

et al. 2022

Cureus

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Background and objective Pediatric guidelines on the diagnosis of celiac disease (CD) have reported that the positivity of anti-endomysium antibodies in the presence of anti-transglutaminase antibodies (TGA) 10 times higher than normal is sufficient for the diagnosis. In this study, we aimed to evaluate whether this diagnostic process for children can also be applied to adult patients. Materials and methods We retrospectively examined patients aged >18 years who were diagnosed with CD. The results of serological tests and endoscopic biopsy were evaluated. Patients with more than one month of duration between celiac serology and endoscopy, those diagnosed with CD before admission, those on a gluten-free diet, and those with selective IgA deficiency were excluded from the study. Results A total of 269 patients were included in the study. TGA value was significantly higher in patients with villous atrophy (p<0.001) and positively correlated with mucosal damage (r=0.60, p<0.01). Considering the cut-off value of 100 U/mL (>10 ULN) for the TGA antibodies, in line with the criteria regulated by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) for the diagnosis of CD, the sensitivity was 71.64%, the specificity was 100%, and the positive predictive value (PPV) was 100%. When the cut-off value was taken as 29.42 U/mL, the sensitivity was 100% and the specificity was 99.5%. For a TGA cut-off value of 52.7 U/mL (5.27 ULN), which determines the presence of partial or complete villous atrophy in the evaluation made considering mucosal damage, the sensitivity was 90%, the specificity was 100%, and the PPV was 100%. Conclusion Based on our findings, TGA titers were highly effective in demonstrating CD-related mucosal damage. This study endorses a biopsy-free strategy in adult patients in line with the ESPGHAN criteria. Local validation of test-specific thresholds will ensure that this approach has a significant impact on adult patients.

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Section: Discussionmentioning

confidence: 99%

“…This study has some other limitations in addition to its retrospective nature. In some studies, it is stated that different TGA commercial kits have a high variability rate [ 15 , 16 ]. We did not use different commercial TGA kits in our study, and we consider this to be the most important limitation of our study.…”

Section: Discussionmentioning

confidence: 99%

A No-Biopsy Approach for the Diagnosis of Celiac Disease in Adults: Can It Be Real?

Baykan¹,

Cerrah²,

Çiftel³

et al. 2022

Cureus

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The global burden of coeliac disease: opportunities and challenges

Makharia

Singh

Catassi

et al. 2022

Nat Rev Gastroenterol Hepatol

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Diagnosing Celiac Disease: Towards Wide-Scale Screening and Serology-Based Criteria?

Popp

Kivelä

Fuchs

et al. 2019

Gastroenterology Research and Practice

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Celiac disease is one of the most common food-related chronic disorders in children. Unfortunately, this multifaceted disease is challenging to recognize and remains markedly underdiagnosed. Screening of either known at-risk groups or even the whole population could increase the suboptimal diagnostic yield substantially. Many recent guidelines recommend screening of at least selected risk groups, but more wide-scale screening remains controversial. The increasing prevalence of celiac disease and the development of autoantibody assays have also led to a gradual shift in the diagnostics towards less invasive serology-based criteria in a subgroup of symptomatic children. The main open questions concern whether these criteria are applicable to all countries and clinical settings, as well as to adult patients. On the other hand, widening screening and the mistaken practice of initiating a gluten-free diet before the appropriate exclusion of celiac disease increase the number of borderline seropositive cases, which may also challenge the classical histopathological diagnostics. Sophisticated diagnostic methods and a deeper understanding of the natural history of early developing celiac disease may prove useful in these circumstances.

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Variability of anti-human transglutaminase testing in celiac disease across Mediterranean countries

Cited by 4 publications

References 7 publications

A No-Biopsy Approach for the Diagnosis of Celiac Disease in Adults: Can It Be Real?

A No-Biopsy Approach for the Diagnosis of Celiac Disease in Adults: Can It Be Real?

The global burden of coeliac disease: opportunities and challenges

Diagnosing Celiac Disease: Towards Wide-Scale Screening and Serology-Based Criteria?

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