Identification of a serum transglutaminase threshold value for the noninvasive diagnosis of symptomatic adult celiac disease patients: a retrospective study

Tola, Marco Di; Marino, Mariacatia; Goetze, Simone; Casale, Rossella; Nardi, S; Borghini, Raffaele; Donato, Giuseppe; Tiberti, Antonio; Picarelli, Antonio

doi:10.1007/s00535-016-1188-y

Cited by 24 publications

(32 citation statements)

References 32 publications

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“…For this reason, while creating an ESPGHAN‐like algorithm for adult patients, it should be taken into consideration that, the clinical, serological, and tissue damage levels are different from pediatric patients, so the cutoff values of the serological tests also differ. Our results were consistent with the study of Tola et al that different threshold levels for pediatric and adult patients must be detected for IgA tTG levels.…”

Section: Discussionsupporting

confidence: 94%

“…When ESPGHAN's threshold value for children was taken into consideration (>200 IU/mL), it was found that the sensitivity decreased to 81%. Similarly, in a study of adult patients in which the threshold value was determined by ROC curve analysis, with the determined anti‐tTG IgA threshold (>3.6‐fold higher), the highest sensitivity (76.8%) was achieved but the sensitivity decreased to 33.5% when the threshold value recommended for children was used …”

Section: Discussionmentioning

confidence: 99%

“…Similarly, in a study of adult patients in which the threshold value was determined by ROC curve analysis, with the determined anti-tTG IgA threshold (>3.6-fold higher), the highest sensitivity (76.8%) was achieved but the sensitivity decreased to 33.5% when the threshold value recommended for children was used. 24 In a meta-analysis involving 34 studies, it has been shown that EMA had a higher specificity when compared with tTG. 16 Although EMA is nonautomated, labor-intensive, and relatively expensive, 16,25 this serologic test had the highest sensitivity and specificity in our study.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of non‐invasive tests with invasive tests in the diagnosis of celiac disease

Gülseren

Adiloğlu

Yücel

et al. 2018

Clinical Laboratory Analysis

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Background/Aims Today, invasive diagnostic tests are necessary for definite diagnosis of adult celiac disease (CD). However, in selected children patients, the need for invasive tests is ceased. In this study, we evaluated adult patients according to the ESPGHAN (European Pediatric Gastroenterology Hepatology and Nutrition Society) criteria. Methods Thirty‐nine patients (aged 17‐66) with symptoms of CD were included. Serum samples were tested for total IgA, tTG‐IgA (antitissue transglutaminase), tTG‐IgG, DGP‐IgA (antideamidated gliadin peptide), DGP‐IgG, and EMA (endomysial antibodies). HLA‐DQ typing was studied with PCR‐SSP (sequence‐specific primers) method. Biopsy samples were evaluated according to Marsh scoring. Results In CD patients, 71.4% (15/21) of the patients were diagnosed without biopsy according to the EPSGHAN criteria but when ESPGHAN's IgA tTG threshold value for children was taken into consideration (>200 IU/mL), the sensitivity decreased to 81%. Celiac disease diagnosed and control groups were compared in terms of HLA tissue types. DQ2.5 homozygous or DQ2.5/DQ2.2 was significantly higher in CD group, and DQ2‐ or DQ8‐negative HLA tissue type was significantly higher in control group. Conclusion When serological tests, HLA typing, and clinical symptoms are all in favor of CD, biopsy may not be performed in selected adult CD patients.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of non‐invasive tests with invasive tests in the diagnosis of celiac disease

Gülseren

Adiloğlu

Yücel

et al. 2018

Clinical Laboratory Analysis

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“…When CD is suspected, the first diagnostic step is most often the analysis of anti-tissue transglutaminase (tTGIgA) [14]. However, this test is also used during follow-up to verify the adherence to a gluten-free diet because it has been shown that more than 90 percent of CD patients on a gluten-free diet will have negative serologies by 5 years [15].…”

Section: Introductionmentioning

confidence: 99%

Identifying True Celiac Disease and Wheat Allergy in the Era of Fashion Driven Gluten-Free Diets

Spoerl

Bastid²,

Ramadan

et al. 2019

Int Arch Allergy Immunol

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Background: Diagnosing both celiac disease (CD) and wheat allergy (WA) might be challenging due to the increasingly popular gluten-free diets. Objectives: This study investigates the value of anti-tissue transglutaminase IgA (tTGIgA) and wheat-specific IgE (WIgE), and identifies clinical and serological features associated with CD and WA. Method: Serological markers of autoimmunity and allergy along with medical charts of patients assessed for tTGIgA and WIgE between 2010 and 2016 were evaluated. Results: During the last years, an increasing number of patients have been tested for tTGIgA, while the number of positive results decreased linearly. Among the 2,965 patients included, 128 patients showed at least once a positive tTGIgA. All patients with tTGIgA levels higher than the 12-fold upper normal limit had CD. The ratio of tTGIgA/total IgA did not perform better as a diagnostic test for CD compared to tTGIgA. tTGIgA and anti-nuclear antibodies were significantly associated. WA was only rarely investigated, particularly in adults. However, positive WIgE were found in nearly 50% of the cases. WIgE and tTGIgA values were negatively correlated. Conclusions: tTGIgA were increasingly tested, while the rate of positive results decreased in recent years, possibly reflecting the impact of current alimentary trends on clinical practice. Associated autoimmune disease was frequently found in CD. High levels of tTGIgA accurately predicted CD diagnosis. WA was rarely investigated and deserves more attention, in particular in children with atopic background. WA does not seem to be associated with CD.

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“…They referred to our Gastroenterology Unit from January 2017 to December 2019. Their CD diagnosis had been previously made according gluten-related signs and symptoms, serum EMA and anti-tTG antibodies positive results, and the histological finding of duodenal villous atrophy (Marsh-Oberhuber type IIIA, B, or C) [20][21][22].…”

Section: Patientsmentioning

confidence: 99%

Beneficial Effects of a Low-Nickel Diet on Relapsing IBS-Like and Extraintestinal Symptoms of Celiac Patients during a Proper Gluten-Free Diet: Nickel Allergic Contact Mucositis in Suspected Non-Responsive Celiac Disease

et al. 2020

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Background and Aim: Nickel (Ni)-rich foods can induce allergic contact mucositis (ACM) with irritable bowel syndrome (IBS)-like symptoms in predisposed subjects. Ni ACM has a high prevalence (>30%) in the general population and can be diagnosed by a Ni oral mucosa patch test (omPT). Many celiac disease (CD) patients on a gluten-free diet (GFD) often show a recrudescence of gastrointestinal and extraintestinal symptoms, although serological and histological remission has been achieved. Since a GFD often results in higher loads of ingested alimentary Ni (e.g., corn), we hypothesized that it would lead to a consequent intestinal sensitization to Ni in predisposed subjects. We wanted to (1) study Ni ACM prevalence in still symptomatic CD patients on a GFD and (2) study the effects of a low-Ni diet (LNiD) on their recurrent symptoms. Material and Methods: We recruited 102 consecutive CD patients (74 female, 28 male; age range 18–65 years, mean age 42.3 ± 7.4) on a GFD since at least 12 months, in current serological and histological remission (Marsh–Oberhuber type 0–I) who complained of relapsing gastrointestinal and/or extraintestinal symptoms. Inclusion criteria: presence of at least three gastrointestinal symptoms with a score ≥5 on the modified Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. Exclusion criteria: IgE-mediated food allergy; history of past or current cancer; inflammatory bowel diseases; infectious diseases including Helicobacter pylori; lactose intolerance. All patients enrolled underwent Ni omPT and followed a LNiD for 3 months. A 24 symptoms questionnaire (GSRS modified according to the Salerno Experts’ Criteria, with 15 gastrointestinal and 9 extraintestinal symptoms) was administered at T0 (free diet), T1 (GFD, CD remission), T2 (recurrence of symptoms despite GFD), and T3 (GFD + LNiD) for comparisons. Comparisons were performed using Wilcoxon signed-rank test. RESULTS: Twenty patients (all female, age range 23–65 years, mean age 39.1 ± 2.9) out of 102 (19.6%) were finally included. All 20 patients enrolled (100%) showed positive Ni omPT, confirming an Ni ACM diagnosis. A correct GFD (T0 vs. T1) induced the improvement of 19 out of the total 24 (79.2%) symptoms, and 14 out of 24 (58.3%) were statistically significant (p-value < 0.0083 according to Bonferroni correction). Prolonged GFD (T1 vs. T2) revealed the worsening of 20 out of the total 24 (83.3%) symptoms, and 10 out of 24 (41.7%) were statistically significant. LNiD (T2 vs. T3) determined an improvement of 20 out of the total 24 (83.4%) symptoms, and in 10 out of 24 (41.7%) symptoms the improvement was statistically significant. Conclusions: Our data suggest that the recrudescence of gastrointestinal and extraintestinal symptoms observed in CD subjects during GFD may be due to the increase in alimentary Ni intake, once gluten contamination and persisting villous atrophy are excluded. Ni overload can induce Ni ACM, which can be diagnosed by a specific Ni omPT. Improvement of symptoms occurs after a proper LNiD. These encouraging data should be confirmed with larger studies.

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Identification of a serum transglutaminase threshold value for the noninvasive diagnosis of symptomatic adult celiac disease patients: a retrospective study

Cited by 24 publications

References 32 publications

Comparison of non‐invasive tests with invasive tests in the diagnosis of celiac disease

Comparison of non‐invasive tests with invasive tests in the diagnosis of celiac disease

Identifying True Celiac Disease and Wheat Allergy in the Era of Fashion Driven Gluten-Free Diets

Beneficial Effects of a Low-Nickel Diet on Relapsing IBS-Like and Extraintestinal Symptoms of Celiac Patients during a Proper Gluten-Free Diet: Nickel Allergic Contact Mucositis in Suspected Non-Responsive Celiac Disease

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