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Antibodies against deamidated gliadin peptides and tissue transglutaminase for diagnosis of pediatric celiac disease.
J Pediatr Gastroenterol Nutr 2012; 55(6):695-700JP

Abstract

OBJECTIVES

The aim of the present study was to evaluate diagnostic performance and actual costs in clinical practice of immumoglobulin (Ig)G/IgA deamidated gliadin peptide antibodies (DGP) as a complement to IgA antibodies against tissue transglutaminase (tTG) for the diagnosis of pediatric celiac disease (CD).

METHODS

All of the consecutive patients younger than 18 years tested for tTG and/or DGP, who underwent duodenal biopsy because of suspected CD in Stockholm and Gothenburg, Sweden, from 2008 to 2010, were included. Medical records were reviewed.

RESULTS

Of 537 children who underwent duodenal biopsy, 278 (52%) had CD. A total of 71 (13%) were younger than 2 years and 16 (4%) had IgA deficiency. Sensitivity and specificity for tTG were 94% and 86%, respectively. Corresponding values for DGP were 91% and 26%. Positive predictive values (PPV) were 88% for tTG and 51% for DGP. There were 148 children who were tTG-negative and DGP-positive, of which only 5% (8/148) had villous atrophy. Among children younger than 2 years with normal IgA, PPV was 96% (25/26) for tTG and 48% (24/50) for DGP. In 16 IgA-deficient children, 11 were DGP positive, of which 5 had CD (PPV 45%). Eight of 278 cases of CD would possibly have been missed without DGP. The cost of adding DGP and consequently more biopsies to be able to detect 8 extra cases of CD was [Euro sign]399,520 or [Euro sign]49,940 per case.

CONCLUSIONS

For diagnosing CD, tTG is superior to DGP, even in children younger than 2 years. Combining tTG and DGP does not provide a better tradeoff between number of missed cases of CD, number of unnecessary duodenal biopsies, and cost than tTG alone.

Authors+Show Affiliations

Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden. ola.olen@ki.seNo 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
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22722680

Citation

Olen, Ola, et al. "Antibodies Against Deamidated Gliadin Peptides and Tissue Transglutaminase for Diagnosis of Pediatric Celiac Disease." Journal of Pediatric Gastroenterology and Nutrition, vol. 55, no. 6, 2012, pp. 695-700.
Olen O, Gudjónsdóttir AH, Browaldh L, et al. Antibodies against deamidated gliadin peptides and tissue transglutaminase for diagnosis of pediatric celiac disease. J Pediatr Gastroenterol Nutr. 2012;55(6):695-700.
Olen, O., Gudjónsdóttir, A. H., Browaldh, L., Hessami, M., Elvin, K., Liedberg, A. S., ... Grahnquist, L. (2012). Antibodies against deamidated gliadin peptides and tissue transglutaminase for diagnosis of pediatric celiac disease. Journal of Pediatric Gastroenterology and Nutrition, 55(6), pp. 695-700. doi:10.1097/MPG.0b013e3182645c54.
Olen O, et al. Antibodies Against Deamidated Gliadin Peptides and Tissue Transglutaminase for Diagnosis of Pediatric Celiac Disease. J Pediatr Gastroenterol Nutr. 2012;55(6):695-700. PubMed PMID: 22722680.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antibodies against deamidated gliadin peptides and tissue transglutaminase for diagnosis of pediatric celiac disease. AU - Olen,Ola, AU - Gudjónsdóttir,Audur H, AU - Browaldh,Lars, AU - Hessami,Mozaffar, AU - Elvin,Kerstin, AU - Liedberg,Ann-Sofie, AU - Neovius,Martin, AU - Grahnquist,Lena, PY - 2012/6/23/entrez PY - 2012/6/23/pubmed PY - 2013/5/1/medline SP - 695 EP - 700 JF - Journal of pediatric gastroenterology and nutrition JO - J. Pediatr. Gastroenterol. Nutr. VL - 55 IS - 6 N2 - OBJECTIVES: The aim of the present study was to evaluate diagnostic performance and actual costs in clinical practice of immumoglobulin (Ig)G/IgA deamidated gliadin peptide antibodies (DGP) as a complement to IgA antibodies against tissue transglutaminase (tTG) for the diagnosis of pediatric celiac disease (CD). METHODS: All of the consecutive patients younger than 18 years tested for tTG and/or DGP, who underwent duodenal biopsy because of suspected CD in Stockholm and Gothenburg, Sweden, from 2008 to 2010, were included. Medical records were reviewed. RESULTS: Of 537 children who underwent duodenal biopsy, 278 (52%) had CD. A total of 71 (13%) were younger than 2 years and 16 (4%) had IgA deficiency. Sensitivity and specificity for tTG were 94% and 86%, respectively. Corresponding values for DGP were 91% and 26%. Positive predictive values (PPV) were 88% for tTG and 51% for DGP. There were 148 children who were tTG-negative and DGP-positive, of which only 5% (8/148) had villous atrophy. Among children younger than 2 years with normal IgA, PPV was 96% (25/26) for tTG and 48% (24/50) for DGP. In 16 IgA-deficient children, 11 were DGP positive, of which 5 had CD (PPV 45%). Eight of 278 cases of CD would possibly have been missed without DGP. The cost of adding DGP and consequently more biopsies to be able to detect 8 extra cases of CD was [Euro sign]399,520 or [Euro sign]49,940 per case. CONCLUSIONS: For diagnosing CD, tTG is superior to DGP, even in children younger than 2 years. Combining tTG and DGP does not provide a better tradeoff between number of missed cases of CD, number of unnecessary duodenal biopsies, and cost than tTG alone. SN - 1536-4801 UR - https://www.unboundmedicine.com/medline/citation/22722680/Antibodies_against_deamidated_gliadin_peptides_and_tissue_transglutaminase_for_diagnosis_of_pediatric_celiac_disease_ L2 - http://dx.doi.org/10.1097/MPG.0b013e3182645c54 DB - PRIME DP - Unbound Medicine ER -