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Value of IgA tTG in Predicting Mucosal Recovery in Children With Celiac Disease on a Gluten-Free Diet.
J Pediatr Gastroenterol Nutr 2017; 64(2):286-291JP

Abstract

OBJECTIVES

Our objective was to determine the rate of mucosal recovery in pediatric patients with celiac disease on a gluten-free diet. We also sought to determine whether immunoglobulin A tissue transglutaminase (tTG) correlates with mucosal damage at the time of a repeat endoscopy with duodenal biopsy in these patients.

METHODS

We performed a retrospective chart review of 103 pediatric patients, younger than 21 years, with a diagnosis of celiac disease defined as Marsh 3 histology, and who underwent a repeat endoscopy with duodenal biopsy at least 12 months after initiating a gluten-free diet.

RESULTS

We found that 19% of pediatric patients treated with a gluten-free diet had persistent enteropathy. At the time of the repeat biopsy, tTG was elevated in 43% of cases with persistent enteropathy and 32% of cases in which there was mucosal recovery. Overall the positive predictive value of the autoantibody tTG was 25% and the negative predictive value was 83% in patients on a gluten-free diet for a median of 2.4 years.

CONCLUSIONS

Nearly 1 in 5 children with celiac disease in our population had persistent enteropathy despite maintaining a gluten-free diet and immunoglobulin A tTG was not an accurate marker of mucosal recovery. Neither the presence of symptoms nor positive serology were predictive of a patient's histology at the time of repeat biopsy. These findings suggest a revisitation of monitring and management criteria of celiac disease in childhood.

Authors+Show Affiliations

*Department of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children†Celiac Research Program, Harvard Medical School‡Division of Gastroenterology and Nutrition§Clinical Research Center, Boston Children's Hospital||Department of Medicine, Massachusetts General Hospital, Boston, MA¶University of Manitoba, Winnipeg, Manitoba, Canada.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
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28112686

Citation

Leonard, Maureen M., et al. "Value of IgA tTG in Predicting Mucosal Recovery in Children With Celiac Disease On a Gluten-Free Diet." Journal of Pediatric Gastroenterology and Nutrition, vol. 64, no. 2, 2017, pp. 286-291.
Leonard MM, Weir DC, DeGroote M, et al. Value of IgA tTG in Predicting Mucosal Recovery in Children With Celiac Disease on a Gluten-Free Diet. J Pediatr Gastroenterol Nutr. 2017;64(2):286-291.
Leonard, M. M., Weir, D. C., DeGroote, M., Mitchell, P. D., Singh, P., Silvester, J. A., ... Fasano, A. (2017). Value of IgA tTG in Predicting Mucosal Recovery in Children With Celiac Disease on a Gluten-Free Diet. Journal of Pediatric Gastroenterology and Nutrition, 64(2), pp. 286-291. doi:10.1097/MPG.0000000000001460.
Leonard MM, et al. Value of IgA tTG in Predicting Mucosal Recovery in Children With Celiac Disease On a Gluten-Free Diet. J Pediatr Gastroenterol Nutr. 2017;64(2):286-291. PubMed PMID: 28112686.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Value of IgA tTG in Predicting Mucosal Recovery in Children With Celiac Disease on a Gluten-Free Diet. AU - Leonard,Maureen M, AU - Weir,Dascha C, AU - DeGroote,Maya, AU - Mitchell,Paul D, AU - Singh,Prashant, AU - Silvester,Jocelyn A, AU - Leichtner,Alan M, AU - Fasano,Alessio, PY - 2017/1/24/entrez PY - 2017/1/24/pubmed PY - 2018/1/3/medline SP - 286 EP - 291 JF - Journal of pediatric gastroenterology and nutrition JO - J. Pediatr. Gastroenterol. Nutr. VL - 64 IS - 2 N2 - OBJECTIVES: Our objective was to determine the rate of mucosal recovery in pediatric patients with celiac disease on a gluten-free diet. We also sought to determine whether immunoglobulin A tissue transglutaminase (tTG) correlates with mucosal damage at the time of a repeat endoscopy with duodenal biopsy in these patients. METHODS: We performed a retrospective chart review of 103 pediatric patients, younger than 21 years, with a diagnosis of celiac disease defined as Marsh 3 histology, and who underwent a repeat endoscopy with duodenal biopsy at least 12 months after initiating a gluten-free diet. RESULTS: We found that 19% of pediatric patients treated with a gluten-free diet had persistent enteropathy. At the time of the repeat biopsy, tTG was elevated in 43% of cases with persistent enteropathy and 32% of cases in which there was mucosal recovery. Overall the positive predictive value of the autoantibody tTG was 25% and the negative predictive value was 83% in patients on a gluten-free diet for a median of 2.4 years. CONCLUSIONS: Nearly 1 in 5 children with celiac disease in our population had persistent enteropathy despite maintaining a gluten-free diet and immunoglobulin A tTG was not an accurate marker of mucosal recovery. Neither the presence of symptoms nor positive serology were predictive of a patient's histology at the time of repeat biopsy. These findings suggest a revisitation of monitring and management criteria of celiac disease in childhood. SN - 1536-4801 UR - https://www.unboundmedicine.com/medline/citation/28112686/Value_of_IgA_tTG_in_Predicting_Mucosal_Recovery_in_Children_With_Celiac_Disease_on_a_Gluten_Free_Diet_ L2 - http://Insights.ovid.com/pubmed?pmid=28112686 DB - PRIME DP - Unbound Medicine ER -