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

J Pediatr Gastroenterol Nutr. 2017 Feb;64(2):286-291. doi: 10.1097/MPG.0000000000001460.

Abstract

Objectives: 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 immunoglobulin A 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 103 pediatric patients, younger than 21 years, with a diagnosis of celiac disease defined as Marsh 3 histology, and who underwent a repeat endoscopy with duodenal biopsy at least 12 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 tTG 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 1 in 5 children with celiac disease in our population had persistent enteropathy despite maintaining a gluten-free diet and immunoglobulin A 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 monitring and management criteria of celiac disease in childhood.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Biomarkers / blood
  • Biopsy
  • Celiac Disease / diagnosis
  • Celiac Disease / diet therapy*
  • Celiac Disease / immunology
  • Celiac Disease / pathology
  • Child
  • Child, Preschool
  • Diet, Gluten-Free*
  • Duodenoscopy
  • Duodenum / diagnostic imaging
  • Duodenum / pathology*
  • Female
  • Follow-Up Studies
  • GTP-Binding Proteins / immunology*
  • Humans
  • Immunoglobulin A / blood*
  • Infant
  • Infant, Newborn
  • Intestinal Mucosa / diagnostic imaging
  • Intestinal Mucosa / pathology*
  • Male
  • Predictive Value of Tests
  • Retrospective Studies
  • Transglutaminases / immunology*
  • Treatment Outcome
  • Young Adult

Substances

  • Biomarkers
  • Immunoglobulin A
  • transglutaminase 2
  • Transglutaminases
  • GTP-Binding Proteins