Pediatr Gastroenterol Hepatol Nutr.  2019 Jul;22(4):350-357. 10.5223/pghn.2019.22.4.350.

Tissue Transglutaminase Antibody and Its Association with Duodenal Biopsy in Diagnosis of Pediatric Celiac Disease

• Meena DK
• Akunuri S
• Meena P
• Bhramer A
• Sharma SD
• Gupta R

• KMID: 2451575
• DOI: http://doi.org/10.5223/pghn.2019.22.4.350

Abstract

PURPOSE
This study aimed to evaluate a possible association between the anti-tissue transglutaminase antibody (anti-tTG) titer and stage of duodenal mucosal damage and assess a possible cut-off value of anti-tTG at which celiac disease (CD) may be diagnosed in children in conjunction with clinical judgment.
METHODS
This observational study was conducted at a gastroenterology clinic in a tertiary hospital from April 2012 to May 2013. Seventy children between 6-months and 18-years-old with suspected CD underwent celiac serology and duodenal biopsy. Statistical analyses were done using SPSS 16. Diagnostic test values were determined for comparing the anti-tTG titer with duodenal biopsy. An analysis of variance and Tukey-Kramer tests were performed for comparing the means between groups. A receiver operating characteristics curve was plotted to determine various cut-off values of anti-tTG.
RESULTS
The mean antibody titer increased with severity of Marsh staging (p<0.001). An immunoglobulin (Ig) A-tTG value at 115 AU/mL had 76% sensitivity and 100% specificity with a 100% positive predictive value (PPV) and 17% negative predictive value (NPV) for diagnosis of CD (p<0.001, 95% confidence interval [CI], 0.75-1).
CONCLUSION
There is an association between the anti-tTG titer and stage of duodenal mucosal injury in children with CD. An anti-tTG value of 115 AU/mL (6.4 times the upper normal limit) had 76% sensitivity, 100% specificity, with a 100% PPV, and 17% NPV for diagnosing CD (95% CI, 0.75-1). This cut-off may be used in combination with clinical judgment to diagnose CD.

Keyword

Duodenitis; Celiac disease; Transglutaminase; Antibodies

MeSH Terms

Antibodies
Biopsy*
Celiac Disease*
Child
Diagnosis*
Diagnostic Tests, Routine
Duodenitis
Gastroenterology
Humans
Immunoglobulins
Judgment
Observational Study
ROC Curve
Sensitivity and Specificity
Tertiary Care Centers
Wetlands
Antibodies
Immunoglobulins

Figure

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  Fig. 1 Flow diagram. tTG: tissue transglutaminase enzyme.

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  Fig. 2 ROC curve for anti-tTG titers and prediction of CD. ROC: receiver operated characteristics, tTG: tissue transglutaminase enzyme, AUC: area under the curve, CD: celiac disease.

• 

  Fig. 3 Correlation between age and anti-tTG titers. tTG: tissue transglutaminase enzyme.

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