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Children with celiac disease and high tTGA are genetically and phenotypically different.
World J Gastroenterol 2013; 19(41):7114-20WJ

Abstract

AIM

To investigate whether celiac disease (CD) patients with tissue-transglutaminase antibody (tTGA) ≥ 100 U/mL are different from patients with lower tTGA levels.

METHODS

Biopsy-proven (Marsh III) pediatric CD patients (n = 116) were prospectively included between March 2009 and October 2012. The biopsies were evaluated by a single pathologist who was blinded to all of the patients' clinical data. The patients were distributed into 2 groups according to their tTGA level, which was measured using enzyme-linked immunoassay: tTGA ≥ 100 U/mL and tTGA < 100 U/mL. The patients'characteristics, symptoms, human leukocyte antigen (HLA) genotype and degree of histological involvement were compared between the 2 groups.

RESULTS

A total of 34 (29.3%) children had tTGA values < 100 U/mL and 82 (70.7%) tTGA levels of ≥ 100 U/mL. Patients with high tTGA levels had lower average body weight-for-height standard deviation scores (SDS) than did patients with tTGA < 100 U/mL (-0.20 ± 1.19 SDS vs 0.23 ± 1.03 SDS, P = 0.025). In the low tTGA group, gastrointestinal symptoms were more common (97.1% vs 75.6%, P = 0.006). More specifically, abdominal pain (76.5% vs 51.2%; P = 0.012) and nausea (17.6% vs 3.7%, P = 0.018) were more frequent among patients with low tTGA. In contrast, patients with solely extraintestinal manifestations were only present in the high tTGA group (18.3%, P = 0.005). These patients more commonly presented with aphthous stomatitis (15.9% vs 0.0%, P = 0.010) and anemia (32.9% vs 11.8%, P = 0.019). In addition, when evaluating the number of CD-associated HLA-DQ heterodimers (HLA-DQ2.5, HLA-DQ2.2 and HLA-DQ8), patients with low tTGA levels more commonly had only 1 disease-associated heterodimer (61.8% vs 31.7%, P = 0.005), while patients with high tTGA more commonly had multiple heterodimers. Finally, patients with tTGA ≥ 100 U/mL more often had a Marsh IIIc lesion (73.2% vs 20.6%, P < 0.001) while in patients with low tTGA patchy lesions were more common (42.4% vs 6.8%, P < 0.001).

CONCLUSION

Patients with tTGA ≥ 100 U/mL show several signs of more advanced disease. They also carry a larger number of CD associated HLA-DQ heterodimers.

Authors+Show Affiliations

Amani Mubarak, Victorien M Wolters, Roderick HJ Houwen, Department of Pediatric Gastroenterology, University Medical Center Utrecht, Wilhelmina Children's Hospital, 3508 AB Utrecht, The Netherlands.No 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

24222955

Citation

Mubarak, Amani, et al. "Children With Celiac Disease and High tTGA Are Genetically and Phenotypically Different." World Journal of Gastroenterology, vol. 19, no. 41, 2013, pp. 7114-20.
Mubarak A, Spierings E, Wolters VM, et al. Children with celiac disease and high tTGA are genetically and phenotypically different. World J Gastroenterol. 2013;19(41):7114-20.
Mubarak, A., Spierings, E., Wolters, V. M., Otten, H. G., ten Kate, F. J., & Houwen, R. H. (2013). Children with celiac disease and high tTGA are genetically and phenotypically different. World Journal of Gastroenterology, 19(41), pp. 7114-20. doi:10.3748/wjg.v19.i41.7114.
Mubarak A, et al. Children With Celiac Disease and High tTGA Are Genetically and Phenotypically Different. World J Gastroenterol. 2013 Nov 7;19(41):7114-20. PubMed PMID: 24222955.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Children with celiac disease and high tTGA are genetically and phenotypically different. AU - Mubarak,Amani, AU - Spierings,Eric, AU - Wolters,Victorien M, AU - Otten,Henny G, AU - ten Kate,Fiebo J W, AU - Houwen,Roderick H J, PY - 2013/01/21/received PY - 2013/06/18/revised PY - 2013/07/04/accepted PY - 2013/11/14/entrez PY - 2013/11/14/pubmed PY - 2014/4/12/medline KW - Anti-tissue transglutaminase antibodies KW - Celiac disease KW - Human leukocyte antigen KW - Phenotype KW - Serology SP - 7114 EP - 20 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 19 IS - 41 N2 - AIM: To investigate whether celiac disease (CD) patients with tissue-transglutaminase antibody (tTGA) ≥ 100 U/mL are different from patients with lower tTGA levels. METHODS: Biopsy-proven (Marsh III) pediatric CD patients (n = 116) were prospectively included between March 2009 and October 2012. The biopsies were evaluated by a single pathologist who was blinded to all of the patients' clinical data. The patients were distributed into 2 groups according to their tTGA level, which was measured using enzyme-linked immunoassay: tTGA ≥ 100 U/mL and tTGA < 100 U/mL. The patients'characteristics, symptoms, human leukocyte antigen (HLA) genotype and degree of histological involvement were compared between the 2 groups. RESULTS: A total of 34 (29.3%) children had tTGA values < 100 U/mL and 82 (70.7%) tTGA levels of ≥ 100 U/mL. Patients with high tTGA levels had lower average body weight-for-height standard deviation scores (SDS) than did patients with tTGA < 100 U/mL (-0.20 ± 1.19 SDS vs 0.23 ± 1.03 SDS, P = 0.025). In the low tTGA group, gastrointestinal symptoms were more common (97.1% vs 75.6%, P = 0.006). More specifically, abdominal pain (76.5% vs 51.2%; P = 0.012) and nausea (17.6% vs 3.7%, P = 0.018) were more frequent among patients with low tTGA. In contrast, patients with solely extraintestinal manifestations were only present in the high tTGA group (18.3%, P = 0.005). These patients more commonly presented with aphthous stomatitis (15.9% vs 0.0%, P = 0.010) and anemia (32.9% vs 11.8%, P = 0.019). In addition, when evaluating the number of CD-associated HLA-DQ heterodimers (HLA-DQ2.5, HLA-DQ2.2 and HLA-DQ8), patients with low tTGA levels more commonly had only 1 disease-associated heterodimer (61.8% vs 31.7%, P = 0.005), while patients with high tTGA more commonly had multiple heterodimers. Finally, patients with tTGA ≥ 100 U/mL more often had a Marsh IIIc lesion (73.2% vs 20.6%, P < 0.001) while in patients with low tTGA patchy lesions were more common (42.4% vs 6.8%, P < 0.001). CONCLUSION: Patients with tTGA ≥ 100 U/mL show several signs of more advanced disease. They also carry a larger number of CD associated HLA-DQ heterodimers. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/24222955/Children_with_celiac_disease_and_high_tTGA_are_genetically_and_phenotypically_different_ L2 - http://www.wjgnet.com/1007-9327/full/v19/i41/7114.htm DB - PRIME DP - Unbound Medicine ER -