Tags

Type your tag names separated by a space and hit enter

Are ESPGHAN "biopsy-sparing" guidelines for celiac disease also suitable for asymptomatic patients?
Am J Gastroenterol 2015; 110(10):1485-9AJ

Abstract

OBJECTIVES

In 2012, European Society of Pediatric Gastroenterology, Hepatology, and Nutrition published novel guidelines on celiac disease (CD) diagnosis. Symptomatic children with serum anti-transglutaminase (anti-tTG) antibody levels ≥10 times upper limit of normal (ULN) could avoid duodenal biopsies after positive HLA test and serum anti-endomysial antibodies (EMAs). So far, both asymptomatic and symptomatic patients with anti-tTG titer <10 times ULN should undergo upper endoscopy with duodenal biopsies to confirm diagnosis. The aim of this study was to assess the accuracy of serological tests to diagnose CD in asymptomatic patients.

METHODS

We retrospectively reviewed data of 286 patients (age range: 10 months to 17 years) with CD diagnosis based on elevated titer of anti-tTG, EMA positivity, and histology. All patients were distinguished between symptomatic and asymptomatic; histological lesions were graded according to the Marsh-Oberhuber (MO) criteria. Fisher exact test was applied to analyze both groups in terms of diagnostic reliability of serological markers.

RESULTS

A total of 196 patients (68.53%) had anti-tTG titers ≥10 times ULN. Among them, a group of 156 patients (79.59%) also had symptoms suggestive of CD ("high-titer" symptomatic); of these, 142 patients (91.02%) showed severe lesion degree (3a, 3b, 3c MO). Conversely, 40 out of 196 patients (20.40%) were asymptomatic ("high-titer" asymptomatic) and 37 patients (92.5%) of them showed severe lesion degree (3a, 3b, 3c MO). No difference in histological damage was found between "high-titer" symptomatic and "high-titer" asymptomatic children (Fisher exact test, P=1.000).

CONCLUSIONS

If confirmed in large multicenter prospective studies, the "biopsy-sparing" protocol seems to be applicable to both symptomatic and asymptomatic patients with anti-tTG titer ≥10 times ULN, positive EMA, and HLA-DQ2/DQ8.

Authors+Show Affiliations

Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy.Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26372508

Citation

Trovato, Chiara Maria, et al. "Are ESPGHAN "biopsy-sparing" Guidelines for Celiac Disease Also Suitable for Asymptomatic Patients?" The American Journal of Gastroenterology, vol. 110, no. 10, 2015, pp. 1485-9.
Trovato CM, Montuori M, Anania C, et al. Are ESPGHAN "biopsy-sparing" guidelines for celiac disease also suitable for asymptomatic patients? Am J Gastroenterol. 2015;110(10):1485-9.
Trovato, C. M., Montuori, M., Anania, C., Barbato, M., Vestri, A. R., Guida, S., ... Valitutti, F. (2015). Are ESPGHAN "biopsy-sparing" guidelines for celiac disease also suitable for asymptomatic patients? The American Journal of Gastroenterology, 110(10), pp. 1485-9. doi:10.1038/ajg.2015.285.
Trovato CM, et al. Are ESPGHAN "biopsy-sparing" Guidelines for Celiac Disease Also Suitable for Asymptomatic Patients. Am J Gastroenterol. 2015;110(10):1485-9. PubMed PMID: 26372508.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are ESPGHAN "biopsy-sparing" guidelines for celiac disease also suitable for asymptomatic patients? AU - Trovato,Chiara Maria, AU - Montuori,Monica, AU - Anania,Caterina, AU - Barbato,Maria, AU - Vestri,Anna Rita, AU - Guida,Sofia, AU - Oliva,Salvatore, AU - Mainiero,Fabrizio, AU - Cucchiara,Salvatore, AU - Valitutti,Francesco, Y1 - 2015/09/15/ PY - 2015/03/01/received PY - 2015/07/01/revised PY - 2015/08/01/accepted PY - 2015/9/16/entrez PY - 2015/9/16/pubmed PY - 2016/1/26/medline SP - 1485 EP - 9 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 110 IS - 10 N2 - OBJECTIVES: In 2012, European Society of Pediatric Gastroenterology, Hepatology, and Nutrition published novel guidelines on celiac disease (CD) diagnosis. Symptomatic children with serum anti-transglutaminase (anti-tTG) antibody levels ≥10 times upper limit of normal (ULN) could avoid duodenal biopsies after positive HLA test and serum anti-endomysial antibodies (EMAs). So far, both asymptomatic and symptomatic patients with anti-tTG titer <10 times ULN should undergo upper endoscopy with duodenal biopsies to confirm diagnosis. The aim of this study was to assess the accuracy of serological tests to diagnose CD in asymptomatic patients. METHODS: We retrospectively reviewed data of 286 patients (age range: 10 months to 17 years) with CD diagnosis based on elevated titer of anti-tTG, EMA positivity, and histology. All patients were distinguished between symptomatic and asymptomatic; histological lesions were graded according to the Marsh-Oberhuber (MO) criteria. Fisher exact test was applied to analyze both groups in terms of diagnostic reliability of serological markers. RESULTS: A total of 196 patients (68.53%) had anti-tTG titers ≥10 times ULN. Among them, a group of 156 patients (79.59%) also had symptoms suggestive of CD ("high-titer" symptomatic); of these, 142 patients (91.02%) showed severe lesion degree (3a, 3b, 3c MO). Conversely, 40 out of 196 patients (20.40%) were asymptomatic ("high-titer" asymptomatic) and 37 patients (92.5%) of them showed severe lesion degree (3a, 3b, 3c MO). No difference in histological damage was found between "high-titer" symptomatic and "high-titer" asymptomatic children (Fisher exact test, P=1.000). CONCLUSIONS: If confirmed in large multicenter prospective studies, the "biopsy-sparing" protocol seems to be applicable to both symptomatic and asymptomatic patients with anti-tTG titer ≥10 times ULN, positive EMA, and HLA-DQ2/DQ8. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/26372508/Are_ESPGHAN_"biopsy_sparing"_guidelines_for_celiac_disease_also_suitable_for_asymptomatic_patients L2 - http://Insights.ovid.com/pubmed?pmid=26372508 DB - PRIME DP - Unbound Medicine ER -