Accuracy of Diagnostic Antibody Tests for Coeliac Disease in Children

Giersiepen, Klaus; Lelgemann, Monika; Stuhldreher, Nina; Ronfani, Luca; Husby, Steffen; Koletzko, Sibylle; Korponay-Szabó, Ilma Rita

doi:10.1097/mpg.0b013e318216f2e5

Cited by 242 publications

(190 citation statements)

References 41 publications

Supporting

Mentioning

170

Contrasting

Unclassified

Order By: Relevance

“…The presence of anti-TG2 antibodies in serum represents a CD marker [4]. However, intestinal anti-TG2 antibodies may be even more relevant from a clinical viewpoint.…”

Section: Discussionmentioning

confidence: 99%

“…It is now clear that, as well as a spectrum of clinical presentations, there is a wide spectrum of alterations of the jejunal histology, ranging from an infiltrative lesion to villous atrophy [3]. Gluten is able to induce the production of autoantibodies that can be found in the serum of CD patients and that have, from a diagnostic viewpoint, a very high sensitivity and specificity [4]. These autoantibodies recognize an endomysial antigen known today as transglutaminase 2 (TG2) [5].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intestinal anti-tissue transglutaminase antibodies in potential coeliac disease

Tosco

Aitoro

Auricchio

et al. 2012

Clinical and Experimental Immunology

View full text Add to dashboard Cite

SummaryAnti-tissue transglutaminase 2 (anti-TG2) antibodies are present in the serum of the great majority of untreated coeliac disease (CD) patients. They are produced and deposited in the small intestinal mucosa. Potential CD patients present serum anti-TG2 antibodies higher than cut-off, but a normal duodenal mucosa where mucosal deposits of anti-TG2 are not always detectable. The aim of our work was to investigate the presence of anti-TG2 intestinal antibodies in patients with potential CD, and identify the most sensitive test to detect them. Twelve active CD patients, 28 potential CD patients and 39 non-CD controls were enrolled. Biopsy fragments from all patients were analysed by double immunofluorescence to detect mucosal deposits of anti-TG2 antibodies. Fragments from the same subjects were also cultured for 24 h with medium in the presence or absence of gliadin peptides. Anti-TG2 autoantibodies secreted into supernatants were measured by enzyme-linked immunosorbent assay. All active CD, 68% of potential CD patients and 20% of non-CD controls showed mucosal deposits of immunoglobulin (Ig)A anti-TG2; at the same time 100, 96 and 8% of active CD, potential CD and non-CD control patients secreted these antibodies in culture supernatants, respectively. Our data showed that, to detect intestinal anti-TG2 antibodies, the measurement of antibodies secreted into culture supernatants has higher sensitivity and specificity (97·5 and 92·3%, respectively) than the detection of mucosal deposits (77·5 and 80·0%, respectively). The measurement of intestinal anti-TG2 antibodies may prove useful in clinical practice to predict evolution towards mucosal atrophy in potential coeliac patients and identify patients with gluten sensitivity.

show abstract

“…The presence of anti-TG2 antibodies in serum represents a CD marker [4]. However, intestinal anti-TG2 antibodies may be even more relevant from a clinical viewpoint.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intestinal anti-tissue transglutaminase antibodies in potential coeliac disease

Tosco

Aitoro

Auricchio

et al. 2012

Clinical and Experimental Immunology

View full text Add to dashboard Cite

show abstract

“…Its characteristics include a variable clinical picture, the presence of specific antibodies of the DQ2 and DQ8 haplotype, and enteropathy [1]. Currently, the antibodies used for serological diagnostics of celiac disease are antibodies against tissue transglutaminase, deamidated gliadin peptides and the endomysium of the smooth muscles of the gastrointestinal tract [2]. The basis for a diagnosis of celiac disease is confirmation of histopathological lesions type 2 or 3, according to the Marsh classification as modified by Oberhuber, i.e.…”

mentioning

confidence: 99%

The Range of Lesions in the Small Intestine of Children with Celiac Disease Determined by Capsule Endoscopy

2014

View full text Add to dashboard Cite

Background. Celiac disease is a chronic gluten intolerance which can cause small intestinal inflammatory lesions of different intensity, scope and distribution. Objectives. The aim of the study was to assess the distribution and scope of lesions revealed by endoscopy in the small intestine of children and adolescents with untreated celiac disease. Material and Methods. A total of nine patients aged from 15 to 18 years (average age: 16 years) were enrolled in the study, including seven girls and two boys who had been diagnosed with histologically confirmed celiac disease. Following a bowel cleansing all the patients were subjected to examination of the small intestine using an endoscopic capsule (EndoCapsule EC, Olympus, Tokyo, Japan). Results. The examination was complete in eight of the patients. In six patients the capsule endoscopy revealed continuous lesions in the duodenum and the proximal small intestine. In one child continuous lesions occurred only in a short section of the bowel, within the duodenum. In one patient the abnormalities were located in the proximal small intestine without any lesions in duodenum. In one case, segmental lesions were observed in the distal small intestine, without any lesions in the duodenum or in the proximal part of the bowel. The results for the endoscopic markers of celiac disease were as follows: in all the patients a significant shortening or complete lack of villous structure was noted; in six patients scalloping was observed at the peaks of the circular folds; in three patients granulation was observed; and in three patients a mosaic mucosal pattern was noted. Conclusions. The most frequent type of lesions revealed by capsule endoscopy in pediatric patients with untreated celiac disease seems to be continuous lesions in the duodenum and the proximal small intestine. Some patients can develop macroscopic lesions (and probably microscopic ones as well) that are beyond the reach of traditional endoscopy. In such cases, capsule endoscopy can help to determine and diagnose celiac disease and to establish the need for lifelong dietary treatment (Adv Clin Exp Med 2014, 23, 5, 785-790).

show abstract

“…It has been suggested that about 20-30% of celiac disease pediatric patients could be diagnosed based solely on high levels of tTGA without the need for an invasive endoscopic procedure [3]. Current guidelines suggest that a tTGA level 10 times over the cut-off level of positivity could be optimal for omitting of duodenal biopsies in celiac disease diagnosis [14].…”

Section: Discussionmentioning

confidence: 99%

“…With the discovery of disease specific autoantibodies and associated genetic markers over the past decades [3], the intestinal biopsy has been questioned as the current golden standard of methods for celiac disease diagnosis [4]. Recently, serology and HLA risk genotypes have been suggested to suffice in the diagnosis of cases with clear symptoms and high tissue transglutaminase autoantibody (tTGA) levels [5].…”

Section: Introductionmentioning

confidence: 99%

Validity of histology for the diagnosis of paediatric coeliac disease: a Swedish multicentre study

Montén

Bjelkenkrantz²,

Gudjonsdottir

et al. 2015

Scandinavian Journal of Gastroenterology

View full text Add to dashboard Cite

Validity of histology for the diagnosis of paediatric coeliac disease: a Swedish multicentre study.Montén, Caroline; Bjelkenkrantz, Kaj; Gudjonsdottir, Audur H; Browaldh, Lars; Arnell, Henrik; Naluai, Åsa Torinsson; Agardh, Daniel Link to publication Citation for published version (APA): Montén, C., Bjelkenkrantz, K., Gudjonsdottir, A. H., Browaldh, L., Arnell, H., Naluai, Å. T., & Agardh, D. (2016). Validity of histology for the diagnosis of paediatric coeliac disease: a Swedish multicentre study. Scandinavian Journal of Gastroenterology, 51(4), 427-433. DOI: 10.3109/00365521.2015.1101486 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal AbstractObjective: Histological evaluation of intestinal biopsies for the diagnosis of celiac disease can be challenging and compatible with risk for misdiagnosis. The aim was to evaluate the agreement of pathological diagnosis for celiac disease in children investigated at four major pediatric university hospitals in Sweden. Material and Methods:Intestinal duodenal biopsies were collected from 402 children at median 9.7 years (1.4-18.3 years). A pathologist at each hospital performed the primary evaluation. A designated pathologist, blinded to the primary evaluation, performed a second Marsh classification of biopsies (M0 to M3c) taken from the bulb and duodenum separately.Kappa (κ) scores between first and second evaluation determined the agreement. Plasma samples were collected at the day of intestinal biopsy and analyzed for tissue transglutaminase autoantibodies (tTGA) using radio ligand binding assays. Results:Marsh scores were concordant in 229/356 biopsies (64%, κ=0.52, p<0.0001). Among discordant results, 15/127 (12%) showed M0 in distal duodenum but ≥M2 in the bulb, whereas the opposite was true for 8/127 (6%) of the biopsies. There were fewer collected duodenal biopsies, more missing bulb biopsies and missing CD3 staining among discordant evaluations. The second evaluation revealed a Marsh score compliant with celiac disease in 22 children of whom 7 children were tTGA positive. Conclusions:The variation between university hospitals on the pathological evaluation of biopsies may lead to misdiagnosis of celiac disease in pediatric patients. Access to clinical and endoscopic information as well as tTGA levels may be useful for the pathologist to complement the evaluation in dubious cases.

show abstract

Accuracy of Diagnostic Antibody Tests for Coeliac Disease in Children

Abstract: IgA-EmA and IgA-anti-TG2 tests appear highly accurate to diagnose CD. IgG-anti-DGP tests may help in excluding CD. IgA-AGA and IgA-DGP tests show inferior accuracy. POC tests may achieve high accuracy in the hands of experienced readers, but IgA-anti-TG2/EmA were superior.

Cited by 242 publications

References 41 publications

Intestinal anti-tissue transglutaminase antibodies in potential coeliac disease

Intestinal anti-tissue transglutaminase antibodies in potential coeliac disease

The Range of Lesions in the Small Intestine of Children with Celiac Disease Determined by Capsule Endoscopy

Validity of histology for the diagnosis of paediatric coeliac disease: a Swedish multicentre study

Contact Info

Product

Resources

About