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Correlation between IgA tissue transglutaminase antibody ratio and histological finding in celiac disease.
J Pediatr Gastroenterol Nutr 2012; 55(1):44-9JP

Abstract

OBJECTIVES

Positivity of both immunoglobulin A anti-tissue transglutaminase (TTG) and anti-endomysium antibodies (EMA) has a positive predictive value of nearly 100% for celiac disease (CD). The objective of the present study was to evaluate whether patients of any age, with high pretest probability of CD and high titre of anti-TTG and EMA positivity, have a high probability of intestinal damage and may not require the biopsy for final diagnosis.

METHODS

A retrospective analysis of 412 consecutively referred patients, age range 10 months to 72 years, who underwent small-bowel biopsy for suspicion of CD and positivity to both anti-TTG and EMA, was performed at 4 Italian centers. Biopsies were evaluated independently by 2 pathologists using Marsh modified classification; in cases of dissimilar results, a third pathologist examined the biopsy. The final histological finding diagnosis was expressed as the prevalent or highest score assigned by the pathologist board.

RESULTS

Three hundred ninety-six patients (96.1%) had histological findings consistent with CD (grade 2 and 3a, 3b, or 3c of modified Marsh classification). An anti-TTG ratio ≥ 7 was able to identify with the 3 assays used (Celikey, anti-TTG immunoglobulin A, EuTTG) all of the patients with significant mucosal damage (Marsh ≥ 2) independent of age and sex; specificity and positive predictive value were 100%. An anti-TTG ratio >20 was more specific (99.8%) for identification of patients with villous atrophy (Marsh 3 a, b, or c).

CONCLUSIONS

Patients with positivity of anti-TTG ≥ 7-fold cutoff, confirmed by positivity to EMA, have a high-degree probability of duodenal damage. In selected conditions, a duodenal biopsy may be avoided and a confirmed greatly positive anti-TTG result could be the basis to prescribe a gluten-free diet.

Authors+Show Affiliations

Department of Laboratory Medicine, Biochemistry Laboratory, Riuniti Hospital, Bergamo, Italy. mgalessio@ospedaliriuniti.bergamo.itNo 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 availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

22197946

Citation

Alessio, Maria G., et al. "Correlation Between IgA Tissue Transglutaminase Antibody Ratio and Histological Finding in Celiac Disease." Journal of Pediatric Gastroenterology and Nutrition, vol. 55, no. 1, 2012, pp. 44-9.
Alessio MG, Tonutti E, Brusca I, et al. Correlation between IgA tissue transglutaminase antibody ratio and histological finding in celiac disease. J Pediatr Gastroenterol Nutr. 2012;55(1):44-9.
Alessio, M. G., Tonutti, E., Brusca, I., Radice, A., Licini, L., Sonzogni, A., ... Villalta, D. (2012). Correlation between IgA tissue transglutaminase antibody ratio and histological finding in celiac disease. Journal of Pediatric Gastroenterology and Nutrition, 55(1), pp. 44-9. doi:10.1097/MPG.0b013e3182470249.
Alessio MG, et al. Correlation Between IgA Tissue Transglutaminase Antibody Ratio and Histological Finding in Celiac Disease. J Pediatr Gastroenterol Nutr. 2012;55(1):44-9. PubMed PMID: 22197946.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Correlation between IgA tissue transglutaminase antibody ratio and histological finding in celiac disease. AU - Alessio,Maria G, AU - Tonutti,Elio, AU - Brusca,Ignazio, AU - Radice,Antonella, AU - Licini,Lisa, AU - Sonzogni,Aurelio, AU - Florena,Ada, AU - Schiaffino,Eugenio, AU - Marus,Wally, AU - Sulfaro,Sandro, AU - Villalta,Danilo, AU - ,, PY - 2011/12/27/entrez PY - 2011/12/27/pubmed PY - 2012/12/10/medline SP - 44 EP - 9 JF - Journal of pediatric gastroenterology and nutrition JO - J. Pediatr. Gastroenterol. Nutr. VL - 55 IS - 1 N2 - OBJECTIVES: Positivity of both immunoglobulin A anti-tissue transglutaminase (TTG) and anti-endomysium antibodies (EMA) has a positive predictive value of nearly 100% for celiac disease (CD). The objective of the present study was to evaluate whether patients of any age, with high pretest probability of CD and high titre of anti-TTG and EMA positivity, have a high probability of intestinal damage and may not require the biopsy for final diagnosis. METHODS: A retrospective analysis of 412 consecutively referred patients, age range 10 months to 72 years, who underwent small-bowel biopsy for suspicion of CD and positivity to both anti-TTG and EMA, was performed at 4 Italian centers. Biopsies were evaluated independently by 2 pathologists using Marsh modified classification; in cases of dissimilar results, a third pathologist examined the biopsy. The final histological finding diagnosis was expressed as the prevalent or highest score assigned by the pathologist board. RESULTS: Three hundred ninety-six patients (96.1%) had histological findings consistent with CD (grade 2 and 3a, 3b, or 3c of modified Marsh classification). An anti-TTG ratio ≥ 7 was able to identify with the 3 assays used (Celikey, anti-TTG immunoglobulin A, EuTTG) all of the patients with significant mucosal damage (Marsh ≥ 2) independent of age and sex; specificity and positive predictive value were 100%. An anti-TTG ratio >20 was more specific (99.8%) for identification of patients with villous atrophy (Marsh 3 a, b, or c). CONCLUSIONS: Patients with positivity of anti-TTG ≥ 7-fold cutoff, confirmed by positivity to EMA, have a high-degree probability of duodenal damage. In selected conditions, a duodenal biopsy may be avoided and a confirmed greatly positive anti-TTG result could be the basis to prescribe a gluten-free diet. SN - 1536-4801 UR - https://www.unboundmedicine.com/medline/citation/22197946/Correlation_between_IgA_tissue_transglutaminase_antibody_ratio_and_histological_finding_in_celiac_disease_ L2 - http://Insights.ovid.com/pubmed?pmid=22197946 DB - PRIME DP - Unbound Medicine ER -