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Titers of anti-tissue transglutaminase antibody correlate well with severity of villous abnormalities in celiac disease.
J Clin Gastroenterol 2015; 49(3):212-7JC

Abstract

GOALS

We reviewed our celiac disease (CeD) database to study if anti-tissue transglutaminase (tTG) antibody (ab) titers correlate with severity of villous abnormalities in Indian patients and to find out a cutoff value of anti-tTG ab fold-rise, which could best predict CeD.

BACKGROUND

Guidelines for diagnosing CeD suggest that biopsy could be avoided in some patients with high anti-tTG ab titer.

STUDY

We reviewed a cohort of 366 anti-tTG ab-positive individuals in whom duodenal biopsies were performed. Anti-tTG ab was obtained before initiation of gluten-free diet. Anti-tTG ab results were expressed in terms of fold-rise by calculating ratio of observed values with cutoff value. CeD was diagnosed if in addition to positive serology, patients had villous atrophy (>Marsh grade 2) and unequivocal response to gluten-free diet.

RESULTS

The mean anti-tTG fold-rise in groups with Marsh grade ≤2 was 2.6 (±2.5), grade 3a was 4.0 (±3.9), 3b was 5.7 (±5.1), and 3c was 11.8 (±8.0). The positive likelihood ratio for diagnosing CeD was 15.4 and 27.4 at 12- and 14-fold-rise of anti-tTG ab titer, respectively. The positive predictive value of diagnosis of CeD was 100% when anti-tTG ab titer was 14-fold higher over the cutoff value. Fifty-seven (43.9%) individuals with anti-tTG titer rise <2-fold high also had CeD.

CONCLUSIONS

As severity of villous abnormality increases, titer of anti-tTG also rises. Presence of villous atrophy can be predicted at very high anti-tTG ab titer. In contrast to emerging belief, mucosal biopsies should be performed even if anti-tTG ab titer is <2 times, because many patients with CeD have low titers.

Authors+Show Affiliations

Departments of *Gastroenterology and Human Nutrition †Pathology ‡Biostatistics, All India Institute of Medical Sciences, New Delhi, India.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

24583754

Citation

Singh, Prashant, et al. "Titers of Anti-tissue Transglutaminase Antibody Correlate Well With Severity of Villous Abnormalities in Celiac Disease." Journal of Clinical Gastroenterology, vol. 49, no. 3, 2015, pp. 212-7.
Singh P, Kurray L, Agnihotri A, et al. Titers of anti-tissue transglutaminase antibody correlate well with severity of villous abnormalities in celiac disease. J Clin Gastroenterol. 2015;49(3):212-7.
Singh, P., Kurray, L., Agnihotri, A., Das, P., Verma, A. K., Sreenivas, V., ... Makharia, G. K. (2015). Titers of anti-tissue transglutaminase antibody correlate well with severity of villous abnormalities in celiac disease. Journal of Clinical Gastroenterology, 49(3), pp. 212-7. doi:10.1097/MCG.0000000000000105.
Singh P, et al. Titers of Anti-tissue Transglutaminase Antibody Correlate Well With Severity of Villous Abnormalities in Celiac Disease. J Clin Gastroenterol. 2015;49(3):212-7. PubMed PMID: 24583754.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Titers of anti-tissue transglutaminase antibody correlate well with severity of villous abnormalities in celiac disease. AU - Singh,Prashant, AU - Kurray,Lalit, AU - Agnihotri,Abhishek, AU - Das,Prasenjit, AU - Verma,Anil Kumar, AU - Sreenivas,Vishnubhatla, AU - Dattagupta,Siddharth, AU - Makharia,Govind K, PY - 2014/3/4/entrez PY - 2014/3/4/pubmed PY - 2015/10/31/medline SP - 212 EP - 7 JF - Journal of clinical gastroenterology JO - J. Clin. Gastroenterol. VL - 49 IS - 3 N2 - GOALS: We reviewed our celiac disease (CeD) database to study if anti-tissue transglutaminase (tTG) antibody (ab) titers correlate with severity of villous abnormalities in Indian patients and to find out a cutoff value of anti-tTG ab fold-rise, which could best predict CeD. BACKGROUND: Guidelines for diagnosing CeD suggest that biopsy could be avoided in some patients with high anti-tTG ab titer. STUDY: We reviewed a cohort of 366 anti-tTG ab-positive individuals in whom duodenal biopsies were performed. Anti-tTG ab was obtained before initiation of gluten-free diet. Anti-tTG ab results were expressed in terms of fold-rise by calculating ratio of observed values with cutoff value. CeD was diagnosed if in addition to positive serology, patients had villous atrophy (>Marsh grade 2) and unequivocal response to gluten-free diet. RESULTS: The mean anti-tTG fold-rise in groups with Marsh grade ≤2 was 2.6 (±2.5), grade 3a was 4.0 (±3.9), 3b was 5.7 (±5.1), and 3c was 11.8 (±8.0). The positive likelihood ratio for diagnosing CeD was 15.4 and 27.4 at 12- and 14-fold-rise of anti-tTG ab titer, respectively. The positive predictive value of diagnosis of CeD was 100% when anti-tTG ab titer was 14-fold higher over the cutoff value. Fifty-seven (43.9%) individuals with anti-tTG titer rise <2-fold high also had CeD. CONCLUSIONS: As severity of villous abnormality increases, titer of anti-tTG also rises. Presence of villous atrophy can be predicted at very high anti-tTG ab titer. In contrast to emerging belief, mucosal biopsies should be performed even if anti-tTG ab titer is <2 times, because many patients with CeD have low titers. SN - 1539-2031 UR - https://www.unboundmedicine.com/medline/citation/24583754/Titers_of_anti_tissue_transglutaminase_antibody_correlate_well_with_severity_of_villous_abnormalities_in_celiac_disease_ L2 - http://Insights.ovid.com/pubmed?pmid=24583754 DB - PRIME DP - Unbound Medicine ER -