Antibodies Against Deamidated Gliadin Peptides and Tissue Transglutaminase for Diagnosis of Pediatric Celiac Disease

J Pediatr Gastroenterol Nutr. 2012 Dec;55(6):695-700. doi: 10.1097/MPG.0b013e3182645c54.

Abstract

Objectives: The aim of the present study was to evaluate diagnostic performance and actual costs in clinical practice of immumoglobulin (Ig)G/IgA deamidated gliadin peptide antibodies (DGP) as a complement to IgA antibodies against tissue transglutaminase (tTG) for the diagnosis of pediatric celiac disease (CD).

Methods: All of the consecutive patients younger than 18 years tested for tTG and/or DGP, who underwent duodenal biopsy because of suspected CD in Stockholm and Gothenburg, Sweden, from 2008 to 2010, were included. Medical records were reviewed.

Results: Of 537 children who underwent duodenal biopsy, 278 (52%) had CD. A total of 71 (13%) were younger than 2 years and 16 (4%) had IgA deficiency. Sensitivity and specificity for tTG were 94% and 86%, respectively. Corresponding values for DGP were 91% and 26%. Positive predictive values (PPV) were 88% for tTG and 51% for DGP. There were 148 children who were tTG-negative and DGP-positive, of which only 5% (8/148) had villous atrophy. Among children younger than 2 years with normal IgA, PPV was 96% (25/26) for tTG and 48% (24/50) for DGP. In 16 IgA-deficient children, 11 were DGP positive, of which 5 had CD (PPV 45%). Eight of 278 cases of CD would possibly have been missed without DGP. The cost of adding DGP and consequently more biopsies to be able to detect 8 extra cases of CD was [Euro sign]399,520 or [Euro sign]49,940 per case.

Conclusions: For diagnosing CD, tTG is superior to DGP, even in children younger than 2 years. Combining tTG and DGP does not provide a better tradeoff between number of missed cases of CD, number of unnecessary duodenal biopsies, and cost than tTG alone.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age Factors
  • Antibodies / blood*
  • Biopsy / economics
  • Celiac Disease / diagnosis*
  • Celiac Disease / economics
  • Celiac Disease / epidemiology
  • Celiac Disease / immunology
  • Child
  • Child, Preschool
  • Duodenum / pathology*
  • Female
  • Gliadin / immunology*
  • Humans
  • IgA Deficiency / epidemiology
  • Immunoglobulin A / metabolism
  • Infant
  • Intestinal Mucosa / pathology*
  • Male
  • Peptides / immunology*
  • Sensitivity and Specificity
  • Sweden / epidemiology
  • Transglutaminases / immunology*

Substances

  • Antibodies
  • Immunoglobulin A
  • Peptides
  • Gliadin
  • Transglutaminases