Anti-tissue transglutaminase antibodies in the follow-up of adult coeliac disease

Aliment Pharmacol Ther. 2009 Aug;30(3):236-44. doi: 10.1111/j.1365-2036.2009.04039.x. Epub 2009 May 12.


Background: The detection of auto antibodies directed against tissue transglutaminase (anti-tTG antibodies) has a well-established role in the diagnosis of coeliac disease, but the value of these antibodies in long-term follow-up is controversial.

Aims: To determine if serial anti-tTG antibody measurements could confirm adherence to a gluten-free diet (GFD) and identify patients at risk of disease complications.

Methods: In a 54-month cohort follow-up study, 182 adult patients were assessed. Data recorded included self-assessment of GFD adherence; anti-tTG antibody concentration and serum ferritin, vitamin B12 and folate. Where available, bone mineral density (BMD) and duodenal histology data were retrieved.

Results: Persistently elevated anti-tTG antibody levels were significantly associated with abnormal duodenal histology (P < 0.001), low ferritin (P < 0.01) and poor adherence to the GFD (P < 0.001). The specificity was >85% while the sensitivity was 39-60%. Anti-tTG antibody concentrations fell rapidly following successful initiation of a GFD, and maintenance of normalization identified those who continued to be adherent to the diet.

Conclusions: This study supports a strategy of using anti-tTG antibody concentrations to monitor newly diagnosed and established patients with coeliac disease, and to target dietetic intervention to reduce the risk of complication.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antibodies / blood
  • Antibodies / immunology*
  • Autoantibodies / blood
  • Autoantibodies / immunology*
  • Bone Density
  • Celiac Disease / complications
  • Celiac Disease / diet therapy*
  • Celiac Disease / immunology
  • Diet, Gluten-Free*
  • Duodenum / anatomy & histology
  • Female
  • Ferritins
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance
  • Risk Factors
  • Transglutaminases / immunology*
  • Vitamin B 12
  • Young Adult


  • Antibodies
  • Autoantibodies
  • Ferritins
  • Transglutaminases
  • Vitamin B 12