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Tissue transglutaminase enzyme-linked immunosorbent assay as a screening test for celiac disease in pediatric patients.

Abstract

OBJECTIVE

An immunoglobulin A (IgA) anti-tissue transglutaminase antibody assay (anti-tTG) was compared with the conventional IgA anti-endomysium antibody assay (EMA) to assess its reliability as a screening test for celiac disease (CD) in a pediatric population.

METHODS

Seventy-five IgA-sufficient and 2 IgA-deficient children who were scheduled for small intestinal biopsy for the evaluation of history or symptoms suggesting a diagnosis of CD were prospectively evaluated and enrolled in this study (gastrointestinal [GI] patients). In addition, 16 children with type I diabetes mellitus (DM) who had a positive EMA and a small bowel biopsy were included as a separate cohort. IgA anti-tTG was measured by enzyme-linked immunosorbent assay (ELISA), and IgA-EMA titers were determined by indirect immunofluorescence on cryopreserved sections of monkey esophagus.

RESULTS

Nine of the 75 IgA-sufficient GI patients had a small bowel biopsy consistent with the diagnosis of CD. Eight of 9 IgA-sufficient patients with a positive small bowel biopsy had positive anti-tTG and EMA tests. Four IgA-sufficient patients had a false-positive anti-tTG ELISA and 2 had a false-positive IgA-EMA assay. In the IgA-sufficient patients, the sensitivity was 89% and the negative predictive value was 98% for either assay. The specificities of the IgA anti-tTG and the IgA-EMA tests were 94% and 97%, respectively (not significant). The positive predictive value of the IgA anti-tTG was 67%, compared with 80% for the IgA-EMA (not significant). In the 2 IgA-deficient children, one of whom had biopsy-proved CD, both tests were negative. In the 16 DM children 12 true- and 4 false-positive IgA anti-tTG and IgA-EMA results were identified. Three of 12 complained of GI symptoms. In follow-up, thus far, none of the DM patients with a false-positive anti-tTG have developed CD.

CONCLUSIONS

The IgA anti-tTG antibody assay is equivalent to the IgA-EMA assay as a screening test for CD in IgA-sufficient pediatric patients. Intestinal biopsy remains the gold standard for the diagnosis of CD.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.

    , ,

    Source

    Pediatrics 107:1 2001 Jan pg E8

    MeSH

    Abdominal Pain
    Adolescent
    Autoantibodies
    Biopsy
    Celiac Disease
    Child
    Child, Preschool
    Diabetes Mellitus, Type 1
    Enzyme-Linked Immunosorbent Assay
    False Negative Reactions
    False Positive Reactions
    Humans
    Immunoglobulin A
    Infant
    Intestine, Small
    Mass Screening
    Predictive Value of Tests
    Prospective Studies
    Reproducibility of Results
    Retrospective Studies
    Transglutaminases

    Pub Type(s)

    Comparative Study
    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    11134472

    Citation

    Chan, A W., et al. "Tissue Transglutaminase Enzyme-linked Immunosorbent Assay as a Screening Test for Celiac Disease in Pediatric Patients." Pediatrics, vol. 107, no. 1, 2001, pp. E8.
    Chan AW, Butzner JD, McKenna R, et al. Tissue transglutaminase enzyme-linked immunosorbent assay as a screening test for celiac disease in pediatric patients. Pediatrics. 2001;107(1):E8.
    Chan, A. W., Butzner, J. D., McKenna, R., & Fritzler, M. J. (2001). Tissue transglutaminase enzyme-linked immunosorbent assay as a screening test for celiac disease in pediatric patients. Pediatrics, 107(1), pp. E8.
    Chan AW, et al. Tissue Transglutaminase Enzyme-linked Immunosorbent Assay as a Screening Test for Celiac Disease in Pediatric Patients. Pediatrics. 2001;107(1):E8. PubMed PMID: 11134472.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Tissue transglutaminase enzyme-linked immunosorbent assay as a screening test for celiac disease in pediatric patients. AU - Chan,A W, AU - Butzner,J D, AU - McKenna,R, AU - Fritzler,M J, PY - 2001/1/3/pubmed PY - 2001/2/28/medline PY - 2001/1/3/entrez SP - E8 EP - E8 JF - Pediatrics JO - Pediatrics VL - 107 IS - 1 N2 - OBJECTIVE: An immunoglobulin A (IgA) anti-tissue transglutaminase antibody assay (anti-tTG) was compared with the conventional IgA anti-endomysium antibody assay (EMA) to assess its reliability as a screening test for celiac disease (CD) in a pediatric population. METHODS: Seventy-five IgA-sufficient and 2 IgA-deficient children who were scheduled for small intestinal biopsy for the evaluation of history or symptoms suggesting a diagnosis of CD were prospectively evaluated and enrolled in this study (gastrointestinal [GI] patients). In addition, 16 children with type I diabetes mellitus (DM) who had a positive EMA and a small bowel biopsy were included as a separate cohort. IgA anti-tTG was measured by enzyme-linked immunosorbent assay (ELISA), and IgA-EMA titers were determined by indirect immunofluorescence on cryopreserved sections of monkey esophagus. RESULTS: Nine of the 75 IgA-sufficient GI patients had a small bowel biopsy consistent with the diagnosis of CD. Eight of 9 IgA-sufficient patients with a positive small bowel biopsy had positive anti-tTG and EMA tests. Four IgA-sufficient patients had a false-positive anti-tTG ELISA and 2 had a false-positive IgA-EMA assay. In the IgA-sufficient patients, the sensitivity was 89% and the negative predictive value was 98% for either assay. The specificities of the IgA anti-tTG and the IgA-EMA tests were 94% and 97%, respectively (not significant). The positive predictive value of the IgA anti-tTG was 67%, compared with 80% for the IgA-EMA (not significant). In the 2 IgA-deficient children, one of whom had biopsy-proved CD, both tests were negative. In the 16 DM children 12 true- and 4 false-positive IgA anti-tTG and IgA-EMA results were identified. Three of 12 complained of GI symptoms. In follow-up, thus far, none of the DM patients with a false-positive anti-tTG have developed CD. CONCLUSIONS: The IgA anti-tTG antibody assay is equivalent to the IgA-EMA assay as a screening test for CD in IgA-sufficient pediatric patients. Intestinal biopsy remains the gold standard for the diagnosis of CD. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/11134472/Tissue_transglutaminase_enzyme_linked_immunosorbent_assay_as_a_screening_test_for_celiac_disease_in_pediatric_patients_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=11134472 DB - PRIME DP - Unbound Medicine ER -