Antitissue Transglutaminase Normalization Postdiagnosis in Children With Celiac Disease

Abstract

GFDC and lower atTG at diagnosis are predictors of earlier normalization. Patients with T1DM are less likely to normalize atTG levels, with longer normalization time. Additional research and education for higher-risk populations are needed.

Antibody Concentrations Decrease 14-Fold in Children With Celiac Disease on a Gluten-Free Diet but Remain High at 3 Months

“…A large retrospective analysis (n ¼ 487) showed that the median normalization time for IgA-TTG is approximately 400 days and that type I diabetes and higher baseline values contribute to longer normalization times. 6 One study in children and adults (n ¼ 25) found a decrease in IgA-TTG for all patients at 50-1102 days (median, 213 d) after starting a GFD and a subsequent increase upon performing a gluten challenge. 22 A 1-year follow-up study in adults (n ¼ 82) found that 80% were positive for IgA-TTG and IgG-DGL after 3 months.…”

“…The guidelines of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition suggest that children with an established diagnosis of CD be followed up regularly for symptomatic improvement and normalization of CD-specific antibody tests. 3 Retrospective analyses have indicated that TTG antibodies normalize after 2 years in 70% to 80% of children on a GFD, that is, the antibody concentration has decreased to less than the manufacturer's upper limit of normal (ULN), 5,6 although there also have been reports of normalization rates as low as 30%. 7 Children and their parents require feedback considerably earlier than after 24 months, and the question that remains is whether antibody tests are useful after 100 days of GFD.…”

“…5,7 A number of pediatric studies have investigated how antibody levels respond to a GFD. [6][7][8][9][10][11][12][13][14][15][16][17][18] Many of those studies used small data sets for children on a GFD (n ¼ 20-93), [7][8][9][10][11][12][13][14][15][16][17][18] used retrospective data, [6][7][8]12,17,18 did not focus primarily on antibody decrease, 9,11,16,17 or had severe limitations in the methods, such as an upper limit in antibody measurements or assumptions of exponential decrease in antibody concentrations over time. 12,13 Here, we present short-term follow-up data for IgA-TTG and IgA-endomysium antibodies (IgA-EMA) together with IgGantibodies to deamidated gliadin peptides (IgG-DGL) in children with CD, prospectively recruited in the diagnostic Antibody diagnostics in paediatric Coeliac Disease (AbCD) study.…”

Investigation of Tissue Transglutaminase Antibody Normalization in Response to Gluten-Free Diet in Children with Celiac Disease

“…Patients with type 1 DM and CD have a higher atTG titer. 22 These patients have a more complex dietary program and consequently lower compliance. 23,24 In 2003, Liu et al indicated that the level of atTG fluctuated over time in DM 1 and CD-susceptible patients.…”

“…Isaac et al reported the median time for normalization of the atTG to be 407 days for 80.5% of patients and 364 days for GFD patients. 22 Hogen Esch et al reported that the cumulative percent of the patients for whom atTG became normal at 6, 12, 18, and 24 months was 35, 55, 64, and 78%, respectively. 26 Current guidelines suggest serial atTG measurements and the normalization could be reached within the 12 months following the GFD.…”