Can We Ignore the Utility of Deamidated Gliadin Peptide in the Diagnosis of Celiac Disease in Children?

Mataya, Leslie; Silvester, Jocelyn A.; Jericho, Hilary

doi:10.1097/mpg.0000000000002377

Cited by 5 publications

(6 citation statements)

References 2 publications

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“…Many laboratories around the world have added de‐amidated gliadin peptide (DGP) antibody‐based assays to their armamentarium to screen for celiac disease (CD) based on the evidence published regarding its usefulness. Majority of the studies reported a diagnostic performance of tissue transglutaminase (TTG)‐IgA assays that was similar or better than DGP‐based serologic tests (1–4) but whether adding DGP test kits to TTG‐IgA improve the diagnostic performance of TTG‐IgA assay has been a controversial issue (5). The celiac serology assays had high sensitivity and specificity in situations of high pretest probability of CD (ie, a clinical setting where prevalence of CD is >40%–50% of the population under study) but scored lower on screening high‐risk groups (eg, type 1 diabetes, family members of index case) where pretest probability of CD is intermediate (5%–15%).…”

mentioning

confidence: 99%

Deamidated Gliadin Antibodies: Do They Add to Tissue Transglutaminase-IgA Assay in Screening for Celiac Disease?

Abdulrahim

Fagih

Troncone³

et al. 2020

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Use of deamidated gliadin peptide (DGP) test kits as adjunctive to tissue-transglutaminase-IgA (TTG-IgA) for the diagnosis of celiac disease (CD) has been a controversial issue. The objectives of our study were to evaluate the diagnostic performance of DGP antibodies compared with TTG-IgA and to evaluate the correlation between DGP-antibody titers and degree of enteropathy. Methods: We included children who underwent endoscopy and biopsies because of positivity of any of the serology tests in the ''celiac profile'' (TTG-IgA, DGP-IgA, and DGP-IgG) from 2012 to 2019. We divided children into clinically suspected cases of CD (group 1) and asymptomatic cases screened as they were from a high-risk group (group 2). Results: Group 1 constituted 52 children and group 2 included 81 children (76 type-1 diabetes [T1D]). The sensitivity and positive-predictive value (PPV) of DGP-IgG in group 1 (90%, 98%) and group 2 (91%, 85.5%) were comparable with TTG-IgA (98%, 92% in group 1; 100%, 80% in group 2). By adding DGP-IgG to TTG-IgA, the performance of TTG-IgA has improved marginally in group 1 (sensitivity 100%, PPV 92.3%). All cases with DGP-IgG titer 2 times ULN in group 1, and >4 times ULN in group 2 had villous atrophy. All T1D patients with TTG IgA >10 times ULN had villous atrophy. Conclusions: DGP-IgG assay did not add to the performance of TTG-IgA. DGP-IgG titer correlated with enteropathy. The diagnosis of CD can be made in asymptomatic T1D child with TTG-IgA titer >10 times ULN and positive endomyseal antibodies.

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confidence: 99%

Deamidated Gliadin Antibodies: Do They Add to Tissue Transglutaminase-IgA Assay in Screening for Celiac Disease?

Abdulrahim

Fagih

Troncone³

et al. 2020

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…13,14 Existing studies on the usefulness of DGP serology in paediatric CD have been limited in size and produced conflicting results. 13,[15][16][17][18][19][20] Our study offers more insight into the utility of DGP antibodies when screening paediatric patients for CD, specifically in those younger than 3 years old. We determined the positive predictive value (PPV), sensitivity and specificity of DPG serologies in addition to the classic tTG serologies in biopsy-confirmed patients with CD under 3 years of age to help guide clinicians' decision-making regarding which serology tests to order when screening for this condition.…”

Section: What This Paper Addsmentioning

confidence: 89%

“…Because of this, it has been recommended to include DGP antibodies when screening this special population 13,14 . Existing studies on the usefulness of DGP serology in paediatric CD have been limited in size and produced conflicting results 13,15–20 . Our study offers more insight into the utility of DGP antibodies when screening paediatric patients for CD, specifically in those younger than 3 years old.…”

Section: What Is Already Known On This Topicmentioning

confidence: 91%

Usefulness of deamidated gliadin peptide antibodies in diagnosing coeliac disease in children younger than 3 years old

Hill

Watkins

Leonard-Puppa

et al. 2021

J Paediatrics Child Health

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Aim The standard serological test to screen for coeliac disease (CD) is tissue transglutaminase (tTG) but some experts recommend including deamidated gliadin peptide (DGP) antibodies for children younger than 3 years old. This study evaluated the utility of DGP‐immunoglobulin A (IgA) and DGP‐immunoglobulin G (IgG) serologies when screening children younger than 3 years old for CD. Methods A retrospective chart review was conducted including children 3 years old and under, who had DGP and/or tTG serologies along with duodenal biopsies during their initial diagnostic evaluation. Serology results were compared to the gold‐standard histopathology by χ2 to determine the significance of including DGP‐IgG/IgA serologies when screening for CD in this age group. Results We identified 478 patients, 52 who were younger than 3 years old, 43 of whom met inclusion criteria. The positive predictive value (PPV) of the DGP‐IgA test was 91.7% whereas, DGP‐IgG was 77.8%. When DGP serology was examined in conjunction with tTG‐IgA, the PPV with DGP‐IgA was 90.9% and with DGP‐IgG was 87.5%. Conclusions In isolation, DGP‐IgA provides a high PPV and specificity for CD in children younger than 3 years old, whereas DGP‐IgG had a much lower PPV in this age group. When used alone or in conjunction with tTG‐IgA, the DGP‐IgA test results in a high PPV of 91.7 and 90.9%, respectively. Based on our study, we recommend obtaining both the DGP‐IgA and the tTG‐IgA serology when screening infants and children younger than 3 years old for coeliac disease.

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“…While TTG IgA is the recommended test for IgA sufficient individuals of all ages, we found that up to 12% of children with CD and normal TTG IgA had an elevated deamidated gliadin peptide IgG level. 68 There should be a low threshold for rescreening earlier if symptoms of CD develop and consideration should be given to the amount of gluten exposure as this may be reduced if a family member is following a GFD.…”

Section: Clini C Al Pre S Entati On S Of Childhood Cdmentioning

confidence: 99%

Review article: Becoming and being coeliac—special considerations for childhood, adolescence and beyond

Chang

O'Shea

Therrien

et al. 2022

Aliment Pharmacol Ther

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Classically considered a disease of early childhood characterised by malabsorption and failure to thrive, coeliac disease is now recognised to arise in genetically susceptible individuals at any age. Although permissive HLA genotypes are the strongest predictor of coeliac disease, they are not sufficient. Several prospective cohort studies enrolling genetically at-risk infants have investigated the role of potential triggers of coeliac disease autoimmunity, such as timing of gluten introduction, viral infections and dietary patterns. Much less is known about triggers of coeliac disease in adulthood. Better understanding of factors leading to coeliac disease may be helpful in the management of those with potential coeliac disease (elevated serum celiac antibodies without villous atrophy in the small intestine), many of whom initiate a gluten-free diet without demonstration of villous atrophy. There are a range of clinical presentations of celiac disease in childhood and patterns of coeliac serology, including fluctuation and spontaneous reversion on a gluten-containing diet, vary.There is a current debate over best strategies to manage adults and children with potential coeliac disease to avoid over-treatment and under-treatment. Childhood and adolescence carry unique issues pertaining to the diagnosis and management of coeliac disease, and include nutrition and growth, rescreening, repeat biopsy, dietary adherence concerns and transition to adult care. In conclusion, while coeliac disease has similar pathogenesis and general clinical manifestations in paediatric and adult populations, diagnostic and management approaches need to adapt to the developmental stages.

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Can We Ignore the Utility of Deamidated Gliadin Peptide in the Diagnosis of Celiac Disease in Children?

Cited by 5 publications

References 2 publications

Deamidated Gliadin Antibodies: Do They Add to Tissue Transglutaminase-IgA Assay in Screening for Celiac Disease?

Deamidated Gliadin Antibodies: Do They Add to Tissue Transglutaminase-IgA Assay in Screening for Celiac Disease?

Usefulness of deamidated gliadin peptide antibodies in diagnosing coeliac disease in children younger than 3 years old

Review article: Becoming and being coeliac—special considerations for childhood, adolescence and beyond

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