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Reliability of antitransglutaminase antibodies as predictors of gluten-free diet compliance in adult celiac disease.
Am J Gastroenterol 2003; 98(5):1079-87AJ

Abstract

OBJECTIVE

Strict lifelong compliance to a gluten-free diet (GFD) minimizes the long-term risk of mortality, especially from lymphoma, in adult celiac disease (CD). Although serum IgA antitransglutaminase (IgA-tTG-ab), like antiendomysium (IgA-EMA) antibodies, are sensitive and specific screening tests for untreated CD, their reliability as predictors of strict compliance to and dietary transgressions from a GFD is not precisely known. We aimed to address this question in consecutively treated adult celiacs.

METHODS

In a cross-sectional study, 95 non-IgA deficient adult (median age: 41 yr) celiacs on a GFD for at least 1 yr (median: 6 yr) were subjected to 1) a dietician-administered inquiry to pinpoint and quantify the number and levels of transgressions (classified as moderate or large, using as a cutoff value the median gluten amount ingested in the overall noncompliant patients of the series) over the previous 2 months, 2) a search for IgA-tTG-ab and -EMA, and 3) perendoscopic duodenal biopsies. The ability of both antibodies to discriminate celiacs with and without detected transgressions was described using receiver operating characteristic curves and quantified as to sensitivity and specificity, according to the level of transgressions.

RESULTS

Forty (42%) patients strictly adhered to a GFD, 55 (58%) had committed transgressions, classified as moderate (< or = 18 g of gluten/2 months; median number 6) in 27 and large (>18 g; median number 69) in 28. IgA-tTG-ab and -EMA specificity (proportion of correct recognition of strictly compliant celiacs) was 0.97 and 0.98, respectively, and sensitivity (proportion of correct recognition of overall, moderate, and large levels of transgressions) was 0.52, 0.31, and 0.77, and 0.62, 0.37, and 0.86, respectively. IgA-tTG-ab and -EMA titers were correlated (p < 0.001) to transgression levels (r = 0.560 and R = 0.631, respectively) and one to another (p < 0.001) in the whole patient population (r = 0.834, N = 84) as in the noncompliant (r = 0.915, N = 48) group. Specificity and sensitivity of IgA-tTG-ab and IgA-EMA for recognition of total villous atrophy in patients under a GFD were 0.90 and 0.91, and 0.60 and 0.73, respectively.

CONCLUSIONS

In adult CD patients on a GFD, IgA-tTG-ab are poor predictors of dietary transgressions. Their negativity is a falsely secure marker of strict diet compliance.

Authors+Show Affiliations

Gastroenterology and Nutritional Support Unit, Lariboisière University Hospital, Paris, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

12809831

Citation

Vahedi, Kouroche, et al. "Reliability of Antitransglutaminase Antibodies as Predictors of Gluten-free Diet Compliance in Adult Celiac Disease." The American Journal of Gastroenterology, vol. 98, no. 5, 2003, pp. 1079-87.
Vahedi K, Mascart F, Mary JY, et al. Reliability of antitransglutaminase antibodies as predictors of gluten-free diet compliance in adult celiac disease. Am J Gastroenterol. 2003;98(5):1079-87.
Vahedi, K., Mascart, F., Mary, J. Y., Laberenne, J. E., Bouhnik, Y., Morin, M. C., ... Matuchansky, C. (2003). Reliability of antitransglutaminase antibodies as predictors of gluten-free diet compliance in adult celiac disease. The American Journal of Gastroenterology, 98(5), pp. 1079-87.
Vahedi K, et al. Reliability of Antitransglutaminase Antibodies as Predictors of Gluten-free Diet Compliance in Adult Celiac Disease. Am J Gastroenterol. 2003;98(5):1079-87. PubMed PMID: 12809831.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reliability of antitransglutaminase antibodies as predictors of gluten-free diet compliance in adult celiac disease. AU - Vahedi,Kouroche, AU - Mascart,Françoise, AU - Mary,Jean Yves, AU - Laberenne,Jean Eric, AU - Bouhnik,Yoram, AU - Morin,Marie Christine, AU - Ocmant,Annick, AU - Velly,Christine, AU - Colombel,Jean Frédéric, AU - Matuchansky,Claude, PY - 2003/6/18/pubmed PY - 2003/7/25/medline PY - 2003/6/18/entrez SP - 1079 EP - 87 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 98 IS - 5 N2 - OBJECTIVE: Strict lifelong compliance to a gluten-free diet (GFD) minimizes the long-term risk of mortality, especially from lymphoma, in adult celiac disease (CD). Although serum IgA antitransglutaminase (IgA-tTG-ab), like antiendomysium (IgA-EMA) antibodies, are sensitive and specific screening tests for untreated CD, their reliability as predictors of strict compliance to and dietary transgressions from a GFD is not precisely known. We aimed to address this question in consecutively treated adult celiacs. METHODS: In a cross-sectional study, 95 non-IgA deficient adult (median age: 41 yr) celiacs on a GFD for at least 1 yr (median: 6 yr) were subjected to 1) a dietician-administered inquiry to pinpoint and quantify the number and levels of transgressions (classified as moderate or large, using as a cutoff value the median gluten amount ingested in the overall noncompliant patients of the series) over the previous 2 months, 2) a search for IgA-tTG-ab and -EMA, and 3) perendoscopic duodenal biopsies. The ability of both antibodies to discriminate celiacs with and without detected transgressions was described using receiver operating characteristic curves and quantified as to sensitivity and specificity, according to the level of transgressions. RESULTS: Forty (42%) patients strictly adhered to a GFD, 55 (58%) had committed transgressions, classified as moderate (< or = 18 g of gluten/2 months; median number 6) in 27 and large (>18 g; median number 69) in 28. IgA-tTG-ab and -EMA specificity (proportion of correct recognition of strictly compliant celiacs) was 0.97 and 0.98, respectively, and sensitivity (proportion of correct recognition of overall, moderate, and large levels of transgressions) was 0.52, 0.31, and 0.77, and 0.62, 0.37, and 0.86, respectively. IgA-tTG-ab and -EMA titers were correlated (p < 0.001) to transgression levels (r = 0.560 and R = 0.631, respectively) and one to another (p < 0.001) in the whole patient population (r = 0.834, N = 84) as in the noncompliant (r = 0.915, N = 48) group. Specificity and sensitivity of IgA-tTG-ab and IgA-EMA for recognition of total villous atrophy in patients under a GFD were 0.90 and 0.91, and 0.60 and 0.73, respectively. CONCLUSIONS: In adult CD patients on a GFD, IgA-tTG-ab are poor predictors of dietary transgressions. Their negativity is a falsely secure marker of strict diet compliance. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/12809831/Reliability_of_antitransglutaminase_antibodies_as_predictors_of_gluten_free_diet_compliance_in_adult_celiac_disease_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=0002-9270&amp;date=2003&amp;volume=98&amp;issue=5&amp;spage=1079 DB - PRIME DP - Unbound Medicine ER -