1. Diagnostic Value of Persistently Low Positive TGA-IgA Titers in Symptomatic Children With Suspected Celiac Disease
- Author
-
Carla Giordano, Monica Montuori, Salvatore Cucchiara, Salvatore Oliva, Annarita Vestri, Annalisa Morelli, Danilo Alunni Fegatelli, Giacomo Caio, and Chiara Marja Trovato
- Subjects
celiac disease ,autoantibodies titer ,children ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Biopsy ,Endomysial antibody ,Disease ,Mucosal atrophy ,Sensitivity and Specificity ,Anti-transglutaminase antibodies ,Antiendomysium antibodies ,Children ,Diagnosis ,Mucosal changes ,Gastroenterology ,NO ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Internal medicine ,Humans ,Medicine ,Child ,Autoantibodies ,Retrospective Studies ,Transglutaminases ,medicine.diagnostic_test ,business.industry ,Esophagogastroduodenoscopy ,Mean value ,Immunoglobulin A ,Titer ,Pediatrics, Perinatology and Child Health ,Duodenal mucosa ,030211 gastroenterology & hepatology ,business - Abstract
OBJECTIVES While the algorithm to diagnose celiac disease (CD) in children with elevated anti-transglutaminase IgA (TGA-IgA) titers (>10 times upper limit of normal, ULN) is well defined, the management of children with low TGA-IgA values represents a clinical challenge. We aimed to identify the diagnostic value of persistently low positive TGA-IgA titers in predicting CD in children. METHODS We retrospectively analyzed children with symptoms or signs of CD, not eligible for a no-biopsy approach. We included children with at least 2 TGA-IgA measurements, endomysial antibody (EMA) assessment and esophagogastroduodenoscopy with biopsies. TGA-IgA values were provided as multiples of ULN. Patients were classified in groups according to median TGA-IgA values: A (TGA-IgA>1 ≤ 5 × ULN; defined as "low-positive"), B (TGA-IgA > 5 < 10 × ULN; "moderate-positive"), and C (controls). RESULTS Data of 281 children were analyzed. Of 162 children in group A, CD was diagnosed in 142 (87.7%), whereas normal duodenal mucosa was found in 20. In group B, all 62 children (100%) received a CD diagnosis. Group C included 57 controls. EMA were undetectable in 31 (15%) of mucosal atrophy cases. On the receiver-operating characteristic curve (area under the curve = 0.910), a mean value of 1.7 ULN showed a sensitivity of 81.4% and specificity of 81.8% to predict mucosal damage. CONCLUSIONS Repeated low or moderate TGA-IgA values (
- Published
- 2021
- Full Text
- View/download PDF