Association of Tissue Transglutaminase Antibody Titer with Duodenal Histological Changes in Children with Celiac Disease

Hawamdeh, Hasan; Al-Zoubi, Basim; Sharqi, Yasameen Al; Qasrawi, Ayman; Abdel-Aziz, Yousef; Barbar, Maha

doi:10.1155/2016/6718590

Cited by 15 publications

(9 citation statements)

References 44 publications

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“…It gives an insight into the importance of assessing gluten intake in nutritional history while interpreting the anti-tTG antibody titers. Similar findings were also observed in a study by Hawamdeh et al where 18% of the patients with Marsh grading III had anti-tTG antibody titers less than 10 times the UNL [ 23 ]. Lewis Scott also reported that 5%-16% of Celiac cases confirmed histologically had negative anti-tTG antibody titers [ 5 ].…”

Section: Discussionsupporting

confidence: 89%

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Association of Anti-tissue Transglutaminase Antibody Titers and Duodenal Biopsy Findings in Pediatric Patients of Celiac Disease

Taneja

Mahajan

Rai

et al. 2021

Cureus

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Aims & Objectives To ascertain the association of serum anti-tissue transglutaminase (anti-tTG) antibody titers with the severity of duodenal mucosal damage on histology and to predict a possible cutoff value of anti-tTG antibody titers for the diagnosis of Celiac disease. Marsh grading greater than two in conjunction with clinical assessment, which may help avert an invasive endoscopic procedure, especially in medically unfit children. Materials & Methods A retrospective study was designed wherein demographic and laboratory data of children aged less than 12 years with raised anti-tTG antibody titers with available histopathology of duodenal biopsies were extracted from the hospital medical records and reviewed. Results A total of 134 children were included in the study, which showed female preponderance. Histopathological changes, characteristic of Celiac disease, were observed in 116 cases; seven among the rest showed evidence of Giardiasis, and 13 could be considered potential Celiac. Of the 116 patients, 1.7% belonged to Marsh grade I, 5.2% grade II and 8.6%, 26.7%, and 57.7% to grade IIIA, IIIB, and IIIC, respectively. A significant association was found between anti-tTG antibody titers and Marsh grading. The cutoff value of anti-tTG antibody titer levels for diagnosing Celiac disease using receiver operating characteristics (ROC) curve in predicting Marsh greater than two at histology was observed to be 84.6 U/ml with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 91.7%, 68.4%, 94.2%, and 59%, respectively. Conclusion An anti-tTG antibody titer greater than 10 times the upper limit of normal (≥84 U/ml) is significantly associated with Marsh grade greater than two. Standard stool microscopy may be used as a simple tool in the workup of all children with raised anti-tTG antibody levels to rule out Giardiasis to avert unnecessary endoscopic evaluation for Celiac disease in such cases.

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Section: Discussionsupporting

confidence: 89%

“…Another study by Hawamdeh et al showed that anti-tTg antibody levels of more than 10 times ULN correlated significantly with CD's histopathological changes. A significant correlation was reported between high anti-tTg antibody titers and higher Marsh grade [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Association of Anti-tissue Transglutaminase Antibody Titers and Duodenal Biopsy Findings in Pediatric Patients of Celiac Disease

Taneja

Mahajan

Rai

et al. 2021

Cureus

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“…25 When correlating tTG (IgA) level with small intestine biopsy results, we found that patients with M3 (a-c) grade of modified Marsh-Oberhuber classification have mean autoanti body levels (337.47 RU/ml) more than that those with M2 grade (mean tTG (IgA) level 252.56 RU/ml), however, this difference not reached significance (P-value 0.07), an information that meriting further evaluation, where small sample size might be a confounding factor. Generally these findings goes with Hawamdeh et al 26 findings in 2016 who concluded a significant association between the degree of duodenal damage and anti-tTG titers, where anti-tTG titer more than 10-folds the ULN (≥180 U/mL) was significantly associated with Marsh III enteropathy; this strong association of high anti-tTG titer and severity of intestinal damage might provide a remarkable evidence for diagnosis of CD when endoscopy is not applicable and fortified by positive EMA test or HLA typing.…”

Section: Discussionsupporting

confidence: 86%

Applying ESPGHAN and WGO Guidelines of Celiac Disease on Iraqi Patients

Alattabi

Aljerrah

2018

J. Contemp. Med. Sci.

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Objective: The goal of the study is to check the degree to which the physicians and pediatricians can apply ESPGHAN and WGO criteria of celiac disease (CD) on their patients in Karbala city. Methods: This is a cross-sectional study conducted in Karbala city hospitals (Al-Hussein-medical city hospital, the pediatric teaching hospital) for the period from August 2017 to February 2018. A random selection of one hundred eight CD patients was carried out and the clinical data including the biopsy results were collected directly from patients or their family members via a questionnaire sheets. Statistically, the quantitative variables were analyzed using non-parametric t-test and the qualitative variables were analyzed using Chi-square test. Results: The study shows that of the total 108 patients, only n=43 (39.8%) of candidates who did biopsy even with tTG IgA>10 fold ULN (200 RU/ml and more) due to the shortage in EMA/HLA tests recommended by ASPGHAN to omit duodenal biopsy., while n=51 (47.2%) accomplished only one of the triple tests (only tTG IgA>10 fold ULN) suggested by ASPGHAN and then applied challenge test and n=14 (12.9) achieved non of the triple tests (tTG IgA antibody titer>5 fold ULN, but <10 fold ULN). On the other hand, the WGO guideline is more suitable if properly applied as it considers tTG (IgA) a convenient substituent of EMA test where high tTG (IgA) serum level being diagnostic and to be confirmed by the available DGP (IgA and IgG) antibodies. Conclusion: The WGO guideline for symptomatic and asymptomatic patients is more applicable for the areas with limited facilities, while ESPGHAN guideline for pediatrics can be applied to a less degree. Generally in Iraq there is a delay in disease diagnosis due to many reasons to be evaluated.

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“…Our findings challenge the need for intestinal biopsy with classic presentation and positive serology. High positivity of the serological marker tTG-IgA was highly correlated with MARSH III histopathological changes [ 11 12 13 ].…”

Section: Discussionmentioning

confidence: 99%

Celiac Disease in South Jordan

Altamimi

2017

Pediatr Gastroenterol Hepatol Nutr

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PurposeCeliac disease, an autoimmune enteropathy triggered by exposure to gluten, is not uncommon in South Jordan. However, its prevalence is underestimated due to lack of physician awareness of the diversity of disease presentation. The clinical spectrum includes classic gastrointestinal manifestations, as well as rickets, iron-deficiency anemia, short stature, elevated liver enzymes, and edema. Our goal was to evaluate celiac disease presentation in clinically diagnosed children.MethodsRetrospective study included all children diagnosed with celiac disease between September 2009 and September 2015. Hospital charts were reviewed. Demographic data, clinical characteristics, and follow-up were recorded.ResultsThirty-five children were diagnosed with celiac disease during the study period. Mean age±standard deviation was 6.7±3.8 years (range, 2.0–14 years). There were 17 (48.6%) female patients. The average duration between onset of symptoms and diagnosis was 16.3±18.7 months. Fifteen (42.9%) patients presented with classic malabsorption symptoms, whereas 7 (20.0%) patients presented with short stature. Positive tissue transglutaminase antibodies (tTg)-immunoglobulin A (IgA) was seen in 34 (97.1%) patients. The one patient with negative tTg-IgA had IgA deficiency. Although tTG-IgA values were not available for objective documentation of compliance, clinical data (resolution of presenting abnormalities and growth improvement) assured acceptable compliance in 22 (62.9%) patients.ConclusionCD in children may present with diverse picture. Although of the small number, the non-classical presentations are not uncommon in our rural community. Gluten-free diet is the main strategy for treatment and associated with usually correction of laboratory abnormalities and improvement of growth.

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Association of Tissue Transglutaminase Antibody Titer with Duodenal Histological Changes in Children with Celiac Disease

Cited by 15 publications

References 44 publications

Association of Anti-tissue Transglutaminase Antibody Titers and Duodenal Biopsy Findings in Pediatric Patients of Celiac Disease

Association of Anti-tissue Transglutaminase Antibody Titers and Duodenal Biopsy Findings in Pediatric Patients of Celiac Disease

Applying ESPGHAN and WGO Guidelines of Celiac Disease on Iraqi Patients

Celiac Disease in South Jordan

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