Repeat Biopsy to Assess Duodenal Healing in Children With Celiac Disease and Eosinophilic Gastrointestinal Disorders

Abstract

The aim of the study was to determine the correlation between duodenal mucosal biopsies and tissue transglutaminase immunoglobulin A (tTG-IgA) levels in pediatric patients with biopsy-confirmed celiac disease (CD) and eosinophilic gastrointestinal disorders (EGID) who have had repeat duodenal biopsies after initiating a gluten-free diet. Methods: A retrospective chart review was performed of children with CD and EGID seen at the Children's Hospital of Philadelphia between 2003 and 2018. Data collected included duodenal biopsy pathology, celiac serology including tTG-IgA, and symptom reports. Duodenal healing was defined as normal villous architecture and no intraepithelial lymphocytes. These data were compared with tTG-IgA level. Data were analyzed with Fisher exact test and t test methods. Results: Thirty-nine patients had normal IgA and diagnoses of both CD and EGID. At second biopsy, 44% (17/39) of patients showed no histologic evidence of active CD and 36% (14/39) of patients had negative tTG-IgA values. Sixty percent (9/15) of patients with no evidence of CD on biopsy had abnormal tTG-IgA levels, and 57% (8/14) of patients with normal tTG-IgA levels had evidence of active disease on biopsy. Conclusions:The data show that an abnormal tTG-IgA drawn after initiation of a gluten-free diet is not correlated with duodenal mucosal injury in pediatric patients with CD and EGID. This suggests that serologic surveillance with tTG-IgA is not sufficient to monitor CD intestinal healing in this patient cohort. Persistent elevations of tTG-IgA in CD patients with normal duodenal biopsies should prompt investigation into other potential causes.

Health‐related quality of life in children with coeliac disease and in their families: A long‐term follow‐up study

“…Although TTG level is a common method to evaluate adherence to GFD, 3 it fails to detect occasional gluten ingestion and, by itself, is not an accurate indicator of mucosal status postdiagnosis. [25][26][27][28] However, it has the benefit of operating independently of patient awareness and does not depend on the accuracy of self-reported gluten consumption. Other limitations of the study include the small number of subjects enroled, the recruitment of patients from a CD specialist regional centre, the possible influence of parents in children's responses, the lack of psychiatric interviews, control group, socioeconomic data and blinded patients (as they knew the results of the TTG before the survey).…”

“…The admission of voluntary consumption of gluten‐containing foods, together with TTG positivity, commonly used during follow‐up, may lead to an underestimation of nonadherence. Although TTG level is a common method to evaluate adherence to GFD, 3 it fails to detect occasional gluten ingestion and, by itself, is not an accurate indicator of mucosal status postdiagnosis 25–28 . However, it has the benefit of operating independently of patient awareness and does not depend on the accuracy of self‐reported gluten consumption.…”