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Tissue transglutaminase enzyme-linked immunosorbent assay as a screening test for celiac disease in pediatric patients.
Pediatrics 2001; 107(1):E8Ped

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.

Authors+Show Affiliations

Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.No affiliation info availableNo affiliation info availableNo affiliation info available

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 -