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High tissue-transglutaminase antibody level predicts small intestinal villous atrophy in adult patients at high risk of celiac disease.
Dig Liver Dis 2012; 44(4):280-5DL

Abstract

BACKGROUND

Duodenal biopsy may be unnecessary to confirm celiac disease in patients with high tissue-transglutaminase antibody level.

AIMS

To define a cut-off value of tissue-transglutaminase antibody with high positive likelihood ratio for duodenal atrophy in patients with suspected celiac disease.

METHODS

We retrospectively identified 945 patients with suspected celiac disease and classified according to the method used for tissue-transglutaminase antibody assay: Group A (n=393, Eu-tTG® Eurospital), Group B (n=263; Eu-tTG® Eurospital) and Group C (n=289; Celikey® Phadia). Duodenal histology was graded according to Marsh. Sensitivity, specificity, and positive likelihood ratio were used to evaluate cut-off points of tissue-transglutaminase antibody as predictor of villous atrophy.

RESULTS

100% specificity and ∞ positive likelihood ratio for duodenal atrophy was observed at a cut-off value of tissue-transglutaminase antibody 5 times higher than the upper limit of normal. CD diagnosis was confirmed by concordance with antiendomysial antibodies, and by reduction of t-TG titre in all patients and improvement of duodenal histology in 80% during gluten-free diet.

CONCLUSIONS

Tissue-transglutaminase antibody level 5-folds the upper limit of normal is 100% specific for duodenal atrophy and using this cut-off biopsy could by avoided in 1/3 of patients. Diagnostic criteria of celiac disease in adults need revision.

Authors+Show Affiliations

Gastroenterology Unit University and Spedali Civili, Brescia, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22119616

Citation

Zanini, Barbara, et al. "High Tissue-transglutaminase Antibody Level Predicts Small Intestinal Villous Atrophy in Adult Patients at High Risk of Celiac Disease." Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, vol. 44, no. 4, 2012, pp. 280-5.
Zanini B, Magni A, Caselani F, et al. High tissue-transglutaminase antibody level predicts small intestinal villous atrophy in adult patients at high risk of celiac disease. Dig Liver Dis. 2012;44(4):280-5.
Zanini, B., Magni, A., Caselani, F., Lanzarotto, F., Carabellese, N., Villanacci, V., ... Lanzini, A. (2012). High tissue-transglutaminase antibody level predicts small intestinal villous atrophy in adult patients at high risk of celiac disease. Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 44(4), pp. 280-5. doi:10.1016/j.dld.2011.10.013.
Zanini B, et al. High Tissue-transglutaminase Antibody Level Predicts Small Intestinal Villous Atrophy in Adult Patients at High Risk of Celiac Disease. Dig Liver Dis. 2012;44(4):280-5. PubMed PMID: 22119616.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High tissue-transglutaminase antibody level predicts small intestinal villous atrophy in adult patients at high risk of celiac disease. AU - Zanini,Barbara, AU - Magni,Alberto, AU - Caselani,Francesca, AU - Lanzarotto,Francesco, AU - Carabellese,Nice, AU - Villanacci,Vincenzo, AU - Ricci,Chiara, AU - Lanzini,Alberto, Y1 - 2011/11/25/ PY - 2011/07/21/received PY - 2011/09/19/revised PY - 2011/10/17/accepted PY - 2011/11/29/entrez PY - 2011/11/29/pubmed PY - 2012/10/30/medline SP - 280 EP - 5 JF - Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver JO - Dig Liver Dis VL - 44 IS - 4 N2 - BACKGROUND: Duodenal biopsy may be unnecessary to confirm celiac disease in patients with high tissue-transglutaminase antibody level. AIMS: To define a cut-off value of tissue-transglutaminase antibody with high positive likelihood ratio for duodenal atrophy in patients with suspected celiac disease. METHODS: We retrospectively identified 945 patients with suspected celiac disease and classified according to the method used for tissue-transglutaminase antibody assay: Group A (n=393, Eu-tTG® Eurospital), Group B (n=263; Eu-tTG® Eurospital) and Group C (n=289; Celikey® Phadia). Duodenal histology was graded according to Marsh. Sensitivity, specificity, and positive likelihood ratio were used to evaluate cut-off points of tissue-transglutaminase antibody as predictor of villous atrophy. RESULTS: 100% specificity and ∞ positive likelihood ratio for duodenal atrophy was observed at a cut-off value of tissue-transglutaminase antibody 5 times higher than the upper limit of normal. CD diagnosis was confirmed by concordance with antiendomysial antibodies, and by reduction of t-TG titre in all patients and improvement of duodenal histology in 80% during gluten-free diet. CONCLUSIONS: Tissue-transglutaminase antibody level 5-folds the upper limit of normal is 100% specific for duodenal atrophy and using this cut-off biopsy could by avoided in 1/3 of patients. Diagnostic criteria of celiac disease in adults need revision. SN - 1878-3562 UR - https://www.unboundmedicine.com/medline/citation/22119616/High_tissue_transglutaminase_antibody_level_predicts_small_intestinal_villous_atrophy_in_adult_patients_at_high_risk_of_celiac_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1590-8658(11)00411-7 DB - PRIME DP - Unbound Medicine ER -