Variability of Histopathological Changes in Childhood Celiac Disease

Dg, Weir; Glickman, Jonathan N.; Roiff, Tracey; Valim, Clarissa; Leichtner, Alan M.

doi:10.1038/ajg.2009.557

Cited by 95 publications

(68 citation statements)

References 16 publications

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“…Only a single pediatric study has assessed clinical characteristics. 19 In a retrospective study of 101 children with newly diagnosed celiac disease, no differences in the mode of presentation USCD (n=10) and conventional disease could be elicited however the study was likely to be underpowered to detect significant differences. investigations that can be associated with a missed celiac diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Immunologic Features of Ultra-Short Celiac Disease

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Clinical and Immunologic Features of Ultra-Short Celiac Disease

et al. 2016

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“…Untreated CD patients exhibit high serum levels of IgA anti-tissue transglutaminase antibodies (tTG), which are highly sensitive and specific for screening suspected subjects for CD [2,3]. The spectrum of histological changes in small bowel biopsies (SBB) is also very wide and does not necessarily correlate with the level of serum anti-tTG antibodies [4]. Anti-tTG deposits in the small intestinal mucosa have been suggested as a sensitive diagnostic tool in early stage CD, when the mucosal morphology is still normal [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Relationships between Clinical Presentation, Serology, Histology, and Duodenal Deposits of Tissue Transglutaminase Antibodies in Pediatric Celiac Disease

Loberman-Nachum¹,

Schvimer²,

Avivi³

et al. 2018

Dig Dis

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Background: The clinical, histological, and serological spectrum of celiac disease (CD) vary widely. We aimed to examine relationships between symptoms, serum anti-tissue transglutaminase antibodies (tTG) levels, mucosal damage, and mucosal anti-tTG deposits in pediatric CD. Methods: A retrospective single-center, cohort study of children referred for endoscopy with suspected CD during 2011–2014. We retrieved the clinical data, blindly reviewed duodenal biopsies, and performed immunohistochemical staining for anti-tTG deposits. Patients were classified as monosymptomatic or polysymptomatic. Mucosal anti-tTG deposits were classified according to the location of deposits, dominant intensity, maximal intensity, and percentage of stained area. Results: Of 252 patients with confirmed CD, complete data were available for 100: 37 males in the age range 1.3–16.7 with median 4.0 years. Monosymptomatic patients (n = 54) presented at an older age than polysymptomatic patients (1.3–15.5, median 8.1 vs. 1.3–16.7, median 6.3 years, p = 0.026). Marsh 2–3c was more prevalent in polysymptomatic patients (93 vs. 78%, p = 0.028). The intensity of mucosal anti-tTG deposits correlated with serum anti-tTG levels but not with the clinical presentation. Conclusions: Multiple symptoms and high serum anti-tTG antibody levels correlated with mucosal damage in children with CD. The role of immunohistochemical staining for intestinal anti-tTG mucosal deposits in the diagnosis of borderline CD is not yet established.

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“…Duodenal histology is frequently unclear and may show variable severity even within a single biopsy fragment. 18 It has been suggested that the duodenal bulb mucosa might be the only area to show histological changes, and therefore biopsies should include distal duodenum and also bulb as biopsy sites to improve the diagnostic yield. 19 Moreover, measurement of fewer than 25 intraepithelial lymphocytes (IEL) per 100 enterocytes correlates with serologic indicators of CD and a higher IEL threshold could miss 50% of cases.…”

Section: Discussionmentioning

confidence: 99%

A new algorithm for the diagnosis of celiac disease

et al. 2011

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Celiac disease (CD) affects at least 1% of the Western population but remains largely unrecognized. In our laboratory, we utilize a novel algorithm to diagnose pediatric CD that offers both high sensitivity and high specificity for diagnosis in an outpatient setting. The aim of the present study was to challenge this algorithm and to test its performance in children and adults suspected of having CD. Using a three-assay algorithm, screening with the most sensitive tissue transglutaminase (tTG) complexed with deamidated gliadin peptide neoepitope immunoglobulin A (IgA)1IgG assay and confirming with the two specific tTG IgA and tTG IgA1IgG assays, we examined the serological results from 112 children aged 0-17 years old and 60 adults in comparison to their respective biopsy results. The algorithm performance was calculated by statistical analysis. The use of the new algorithm enabled us to diagnose CD with 98% sensitivity, 93% specificity and 95% accuracy in the pediatric group and 94% sensitivity, 92% specificity and 93% accuracy in the total population studied. The false-negative cases in the adult group were attributed to previous adherence to a gluten-free diet, and the single false-negative result in a young child became a true positive after 6 months. We have also monitored three celiac patients before and after diagnosis and found that the algorithm may be suitable for disease monitoring. The newly proposed three-assay algorithm for celiac detection is very reliable in both children and adults. Due to the high performance of this assay, the further need for confirmatory intestinal biopsies will be reassessed.

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Variability of Histopathological Changes in Childhood Celiac Disease

Cited by 95 publications

References 16 publications

Clinical and Immunologic Features of Ultra-Short Celiac Disease

Clinical and Immunologic Features of Ultra-Short Celiac Disease

Relationships between Clinical Presentation, Serology, Histology, and Duodenal Deposits of Tissue Transglutaminase Antibodies in Pediatric Celiac Disease

A new algorithm for the diagnosis of celiac disease

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