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Will the Real Coeliac Disease Please Stand Up? Coeliac Disease Prevalence in the German LIFE Child Study.
J Pediatr Gastroenterol Nutr. 2018 10; 67(4):494-500.JP

Abstract

OBJECTIVES

Assessing the seroprevalence and the prevalence of definite coeliac disease (CD) in the German LIFE Child Health study cohort including immunoglobulin A (IgA) antibodies against tissue transglutaminase (IgA-TTG) in addition to IgG antibodies against deamidated gliadin peptides (IgG-DGP) and human leukocyte antigen (HLA)-DQ2/8 genotyping.

METHODS

Samples from children and adolescents were first screened for IgA-TTG and IgG-DGP. If IgA-TTG was above 0.5 times the upper limit of normal and/or IgG-DGP was positive, IgA antibodies against endomysium (IgA-EmA) were measured, and HLA was genotyped. In patients with only IgG-DGP positivity, total IgA was assayed. Subjects with suspicious results were followed up serologically and, in case of repeatedly positive antibody results, invited for a personal interview. Further diagnostic data were obtained independent from our study.

RESULTS

We screened 2363 children's blood samples collected from 2011 to 2015. The seroprevalence, that is, IgA-TTG and/or IgA-EmA positivity or IgG-DGP positivity with IgA <0.05 g/L, was 1.57% (95% confidence interval [CI95%] 1.14-2.15). The prevalence of suspected CD, that is, seroprevalence and compatible HLA genotype with hitherto unknown mucosal damage, was 1.35% (CI95% 0.96-1.91). Definite CD, that is, seropositivity accompanied by positive intestinal biopsy or IgA-TTG ≥ 10 × upper limit of normal, was found in 0.42% (CI95% 0.22-0.80). Seven children claimed to have CD. The HLA haplotype, however, matched in only 4 of them resulting in an overall CD prevalence of at least 0.59% (CI95% 0.34-1.02). Thirteen unclear cases remained; therefore, the prevalence may even be higher.

CONCLUSIONS

The prevalence of definite CD in a population-representative German cohort is higher than previously described. HLA-DQ typing is helpful to identify false-positive IgA-TTG patients negative for IgA-EmA and/or IgG-DGP under screening conditions and unmasks possible misdiagnoses of CD.

Authors+Show Affiliations

Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research.Institute of Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics.Clinical Trial Centre.Institute of Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics. LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig.LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig.Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research.Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research. LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig.Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research. LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig.Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research. LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig.EUROIMMUN Medizinische Labordiagnostika AG, Lübeck/Dassow, Germany.Institute of Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics. LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig.Institute of Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29901554

Citation

Händel, Norman, et al. "Will the Real Coeliac Disease Please Stand Up? Coeliac Disease Prevalence in the German LIFE Child Study." Journal of Pediatric Gastroenterology and Nutrition, vol. 67, no. 4, 2018, pp. 494-500.
Händel N, Mothes T, Petroff D, et al. Will the Real Coeliac Disease Please Stand Up? Coeliac Disease Prevalence in the German LIFE Child Study. J Pediatr Gastroenterol Nutr. 2018;67(4):494-500.
Händel, N., Mothes, T., Petroff, D., Baber, R., Jurkutat, A., Flemming, G., Kiess, W., Hiemisch, A., Körner, A., Schlumberger, W., Thiery, J., & Wolf, J. (2018). Will the Real Coeliac Disease Please Stand Up? Coeliac Disease Prevalence in the German LIFE Child Study. Journal of Pediatric Gastroenterology and Nutrition, 67(4), 494-500. https://doi.org/10.1097/MPG.0000000000002052
Händel N, et al. Will the Real Coeliac Disease Please Stand Up? Coeliac Disease Prevalence in the German LIFE Child Study. J Pediatr Gastroenterol Nutr. 2018;67(4):494-500. PubMed PMID: 29901554.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Will the Real Coeliac Disease Please Stand Up? Coeliac Disease Prevalence in the German LIFE Child Study. AU - Händel,Norman, AU - Mothes,Thomas, AU - Petroff,David, AU - Baber,Ronny, AU - Jurkutat,Anne, AU - Flemming,Gunter, AU - Kiess,Wieland, AU - Hiemisch,Andreas, AU - Körner,Antje, AU - Schlumberger,Wolfgang, AU - Thiery,Joachim, AU - Wolf,Johannes, PY - 2018/6/15/pubmed PY - 2019/11/12/medline PY - 2018/6/15/entrez SP - 494 EP - 500 JF - Journal of pediatric gastroenterology and nutrition JO - J Pediatr Gastroenterol Nutr VL - 67 IS - 4 N2 - OBJECTIVES: Assessing the seroprevalence and the prevalence of definite coeliac disease (CD) in the German LIFE Child Health study cohort including immunoglobulin A (IgA) antibodies against tissue transglutaminase (IgA-TTG) in addition to IgG antibodies against deamidated gliadin peptides (IgG-DGP) and human leukocyte antigen (HLA)-DQ2/8 genotyping. METHODS: Samples from children and adolescents were first screened for IgA-TTG and IgG-DGP. If IgA-TTG was above 0.5 times the upper limit of normal and/or IgG-DGP was positive, IgA antibodies against endomysium (IgA-EmA) were measured, and HLA was genotyped. In patients with only IgG-DGP positivity, total IgA was assayed. Subjects with suspicious results were followed up serologically and, in case of repeatedly positive antibody results, invited for a personal interview. Further diagnostic data were obtained independent from our study. RESULTS: We screened 2363 children's blood samples collected from 2011 to 2015. The seroprevalence, that is, IgA-TTG and/or IgA-EmA positivity or IgG-DGP positivity with IgA <0.05 g/L, was 1.57% (95% confidence interval [CI95%] 1.14-2.15). The prevalence of suspected CD, that is, seroprevalence and compatible HLA genotype with hitherto unknown mucosal damage, was 1.35% (CI95% 0.96-1.91). Definite CD, that is, seropositivity accompanied by positive intestinal biopsy or IgA-TTG ≥ 10 × upper limit of normal, was found in 0.42% (CI95% 0.22-0.80). Seven children claimed to have CD. The HLA haplotype, however, matched in only 4 of them resulting in an overall CD prevalence of at least 0.59% (CI95% 0.34-1.02). Thirteen unclear cases remained; therefore, the prevalence may even be higher. CONCLUSIONS: The prevalence of definite CD in a population-representative German cohort is higher than previously described. HLA-DQ typing is helpful to identify false-positive IgA-TTG patients negative for IgA-EmA and/or IgG-DGP under screening conditions and unmasks possible misdiagnoses of CD. SN - 1536-4801 UR - https://www.unboundmedicine.com/medline/citation/29901554/Will_the_Real_Coeliac_Disease_Please_Stand_Up_Coeliac_Disease_Prevalence_in_the_German_LIFE_Child_Study_ L2 - https://doi.org/10.1097/MPG.0000000000002052 DB - PRIME DP - Unbound Medicine ER -