Antitissue transglutaminase antibodies’ normalization after starting a gluten-free diet in a large population of celiac children-a real-life experience

Sbravati, Francesca; Cosentino, A; Lenzi, Jacopo; Fiorentino, Michelangelo; Ambrosi, Francesca; Salerno, Angela; Biase, Annarita Di; Righi, Beatrice; Brusa, Sandra; Valin, Paola Sogno; Bruni, Luigino; Battistini, Barbara; Pagano, Sara; Grondona, Ana Gabriela; Labriola, Flavio; Alvisi, Patrizia

doi:10.1016/j.dld.2021.06.026

Cited by 12 publications

(12 citation statements)

References 31 publications

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“…Recent studies suggest that tTGA should normalize within 18–24 months after initiation of a GFD ( 14 ). Similar to other studies ( 38 , 39 ), >90% of the children in our cohort had normalized tTGA. We found no difference in tTGA levels between children with and those without follow-up of CD.…”

Section: Discussionsupporting

confidence: 92%

Lack of Follow-Up for Celiac Disease During Childhood Not Associated With Poor Health Outcomes: A Regional Swedish Cohort Study

Ulnes

Albrektsson

Størdal

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: To examine the association between the lack of follow-up for celiac disease (CD) during childhood and dietary adherence, disease remission, and health-related quality of life. Methods: We invited 243 randomly selected children diagnosed with CD in 2013-2018 in Gothenburg, Sweden, and 162 consented to participate (67%). We retrieved information on clinical follow-up and current wellbeing using medical and laboratory records data, as well as validated questionnaires on symptoms of CD, dietary adherence, and health-related quality of life. We analyzed tissue-transglutaminase antibodies as a measure of disease remission. We defined lack of follow-up as no CD-related physician/dietician-led visit or measurement of tissue-transglutaminase antibodies over the past 24 months of study enrollment. Results: The mean age at study enrolment was 12.7 (range 7.8-18.2) years. Out of 162 children with an average disease duration of 5.3 (range 2.3-8.8) years, 23 (14%) lacked follow-up. Tissue-transglutaminase antibodies had normalized in 94% (95% confidence interval [CI]=71-100) of children without follow-up versus 91% (95%CI=85-95%) of children with continued follow-up. Of children without follow-up, 65% (95%CI=38-86%) reported a dietary adherence score indicating very good adherence, versus 72% (95%CI=63-80%) of those with continued follow-up. Also, lack of follow-up was not signficantly associated with growth, symptom scores, or health-related quality of life. Conclusions: In this regional cohort study of mostly older children and adolescents, lack of follow-up for CD was not significantly linked to dietary adherence, disease remission, or health-related quality of life. How these results hold in larger, unselected samples with longer follow-up, including transition to adult care, warrants further study.

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Section: Discussionsupporting

confidence: 92%

Lack of Follow-Up for Celiac Disease During Childhood Not Associated With Poor Health Outcomes: A Regional Swedish Cohort Study

Ulnes

Albrektsson

Størdal

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…They did not collect data at 12m after diagnosis. Ziv-Baran et al have found anemia at CD diagnosis to be correlated with TTG titer but not with histological Marsh classi cation among 432 pediatric CD patients[15]. In our cohort iron de ciency at CD diagnosis was present in 57 (54.8%) but only in 25 (24%) after 1y of GFD.…”

contrasting

confidence: 50%

“…This nding is in line with a recent multicenter large cohort of children with celiac disease on a GFD from Italy which reported female sex as a risk factor associated with a longer time to serology normalization. TTG > 10 ULN at diagnosis, age 7-12 years old, poor compliance to diet and non-Caucasian ethnicity were other signi cant independent risk factors the found [15].…”

Section: Discussionmentioning

confidence: 79%

The association between iron deficiency at diagnosis, female sex and tissue transglutaminase antibody normalization in pediatric Celiac disease

Zifman

Schujovitzky

Moskovitz-Hivert

et al. 2023

Preprint

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Objectives: Iron deficiency (ID) is one of the most common manifestations of Celiac disease (CD). We aimed to determine whether ID at CD diagnosis affects tissue transglutaminase antibody (TTG) normalization rate among pediatric CD patients adhering to gluten free diet (GFD). Methods: We conducted a retrospective, observational cohort study which enrolled CD subjects aged 2-18y, diagnosed between Jan 2016 and Dec 2020. Demographic and laboratory data were collected at diagnosis and 1y after adherence to GFD. ID was determined according to hemoglobin and ferritin levels. We compared CD subjects with and without ID at CD diagnosis in relation to TTG normalization at 1y. Results: Our cohort included 118 pediatric CD subjects. At diagnosis 61 (51.7%) of CD subjects had ID, of whom 27 (44.3%) were female, compared to 46 (80.7%) females in the non-ID group (p<0.001). Median age at CD diagnosis was 5.7y (IQR 4-8.4, range 2-14) and 7.2y (IQR 4.7-10.8, range 0.9-16) and among those with and without ID, respectively (p=0.1). After 1y of adherence to GFD, TTG normalization was achieved in 38 (65.5%) and 28 (53.8%) in those with and without ID at CD diagnosis, respectively (p=0.21). However, TTG normalization was achieved in 38 (79.2%) of males compared to 42 (49.4%) of females (p=0.001). Conclusions: ID at the time of diagnosis was not associated with lower rates of TTG normalization at 1y among pediatric CD patients adhering to GFD. However, TTG normalization at 1y was significantly more frequent among male subjects compared to females.

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“…The circulating levels of antibodies to transglutaminase, endomysium and deamidated gliadin peptides provide an indirect immune readout of disease activity 79 . Coeliac serology generally normalises on a GFD, mostly by 24–36 months 80 . The amount and duration of gluten required to trigger an increase are highly variable 81 .…”

Section: Monitoring the Gfdmentioning

confidence: 99%

“…79 Coeliac serology generally normalises on a GFD, mostly by 24-36 months. 80 The amount and duration of gluten required to trigger an increase are highly variable. 81 While coeliac serology is frequently used as a surrogate marker of intestinal healing they each have poor sensitivity for detecting villous atrophy (50% for transglutaminase antibodies), with similar levels of performance in paediatric and adult patients.…”

Section: Coeliac Serologymentioning

confidence: 99%

Review article: Follow‐up of coeliac disease

Tye–Din

2022

Aliment Pharmacol Ther

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Coeliac disease is a lifelong immune-mediated enteropathy associated with important systemic manifestations. 1,2 A strict gluten-free diet (GFD) is the cornerstone of management but does not resolve the underlying immune cause of coeliac disease. 3 The GFD imparts a substantial treatment burden, 4 and many patients fail to achieve complete symptom or mucosal remission. As coeliac disease is associated with increased morbidity and modestly increased mortality, periodic medical follow-up is considered a crucial component of patient care [5][6][7][8] but this is compromised by the paucity of evidence to inform best-practice approaches. 9,10 As a result, real-world follow-up is often inconsistent or absent altogether. [11][12][13] For many chronic illnesses, such as type 1 diabetes, the importance of maintaining long-term follow-up to assess disease status, treatment efficacy and monitor for complications is well established in the medical community, however, for coeliac disease, this is typically not the case, even though the monitoring goals are the same. 5,6,7,8,14 For patients, the key goals of treatment are to resolve symptoms, reduce the risk of complications and achieve optimal quality of life, and for clinicians, disease remission also encompasses healing of the enteropathy. Effective models of care that leverage local medical and allied health expertise, ideally involving a gastroenterologist, dietitian and primary care provider, will support these goals but willThe Handling Editor for this article was Professor Peter Gibson, and it was accepted for publication after full peer-review.

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Antitissue transglutaminase antibodies’ normalization after starting a gluten-free diet in a large population of celiac children-a real-life experience

Cited by 12 publications

References 31 publications

Lack of Follow-Up for Celiac Disease During Childhood Not Associated With Poor Health Outcomes: A Regional Swedish Cohort Study

Lack of Follow-Up for Celiac Disease During Childhood Not Associated With Poor Health Outcomes: A Regional Swedish Cohort Study

The association between iron deficiency at diagnosis, female sex and tissue transglutaminase antibody normalization in pediatric Celiac disease

Review article: Follow‐up of coeliac disease

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