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Clinical and histopathological correlation of duodenal biopsy with IgA anti-tissue transglutaminase titers in children with celiac disease

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Abstract

Background

Data correlating anti-tissue transglutaminase (tTG) antibody titers with severity of duodenal involvement is limited.

Objective

The aim of this study was to correlate IgA anti-tTG antibody titers with symptoms, anthropometric parameters, and duodenal histopathology.

Methods

Consecutively diagnosed patients of celiac disease as per modified ESPGHAN criteria presenting over a year were enrolled. Demographic data, symptoms, weight-for-age z score (WAZ), height-for-age z score (HAZ), IgA anti-tTG titer, and duodenal histopathology graded as per modified Marsh criteria were recorded. Spearman rank correlation test was used for association between TTG age, WAZ, and HAZ. Receiver operating curve (ROC), sensitivity, specificity, negative predictive value, and positive predictive value were used to obtain anti-tTG cutoff value predictive of Marsh grade 3.

Results

One hundred and forty-two patients with celiac disease were evaluated. tTG showed significant correlation with WAZ (r = 0.822, p = <0.001) and HAZ (r = 0.722, p = <0.001) but not with age (r = 0.202, p = 0.066). The median anti-tTG titers rose progressively with higher Marsh grade on histopathology (p = 0.001). The median anti-tTG titer was also significantly higher in patients with classic celiac disease as compared to non-diarrheal celiac disease (144 u/mL vs. 27, p = 0.02). Anti-tTG titer of 62.5 u/mL was strongly predictive of duodenal histology of Marsh grade 3a and higher with sensitivity, specificity, positive predictive value, and negative predictive value of 95.4 %, 98 %, 93.8 %, and 88.3 % respectively.

Conclusions

There is a significant correlation between IgA anti-tTG titers and anthropometric parameters and severity of duodenal histopathology. With further validation, strongly positive titers may be sufficient to predict severity of this disease.

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Conflict of interest

MB, AL, PS, APD, and SK all declare that they have no conflict of interest.

Ethical statement

The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning Human and Animal Rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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Authors and Affiliations

  1. Department of Pediatrics, Lok Nayak Hospital and Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, 110 002, India

    Malobika Bhattacharya, Avinash Lomash, Anand Prakash Dubey & Seema Kapoor

  2. Department of Pathology, G B Pant Hospital, Jawaharlal Nehru Marg, New Delhi, 110 002, India

    Puja Sakhuja

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  1. Malobika Bhattacharya
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  2. Avinash Lomash
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  3. Puja Sakhuja
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  4. Anand Prakash Dubey
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  5. Seema Kapoor
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Corresponding author

Correspondence to Seema Kapoor.

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Bhattacharya, M., Lomash, A., Sakhuja, P. et al. Clinical and histopathological correlation of duodenal biopsy with IgA anti-tissue transglutaminase titers in children with celiac disease. Indian J Gastroenterol 33, 350–354 (2014). https://doi.org/10.1007/s12664-014-0464-0

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  • DOI: https://doi.org/10.1007/s12664-014-0464-0

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