Skip to main content
SpringerLink
Log in

Tissue Transglutaminase Levels Are Not Sufficient to Diagnose Celiac Disease in North American Practices Without Intestinal Biopsies

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Celiac serology is crucial for the diagnosis of celiac disease in children. The American guideline for celiac disease in children suggested that positive serology should be followed by confirmatory intestinal histology. The relationship between high tissue transglutaminase titers and celiac disease in children has not been well investigated in children from North America.

Aims

In the present study, we investigated whether different tissue transglutaminase titers in symptomatic children could predict celiac disease without the confirmation of intestinal histology.

Methods

Data from biopsy confirmed celiac children were collected from four different clinics in North America. Clinical, serological, histological, and follow-up data were collected. The accuracy rates of various tissue transglutaminase titers to predict celiac disease in children were calculated.

Results

The data from 240 children were calculated. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate of tissue transglutaminase titers at ≥10× upper limit of normal were 75.4, 48.8, 87.7, 29.0, and 70.8 %, respectively. Similar data were noted in the other tissue transglutaminase titers (≥3× upper limit of normal, >100 U/ml, or >100 U/ml and >10× upper limit of normal).

Conclusions

The positive predictive value of tissue transglutaminase titers at ≥3× upper limit of normal or higher was too low to predict celiac disease in children. Our data suggested that in routine clinical practice, high titers of tissue transglutaminase are not sufficient to diagnose celiac disease in North American children without intestinal biopsies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and non-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003;163:286–292.

    Article  PubMed  Google Scholar 

  2. Fassano J, Araya M, Bhatnagar S, et al. Federation of international societies of Pediatric Gastroenterology Hepatology and Nutrition consensus report on celiac disease. Pediat Gastroenterol Nutr. 2008;47:214–219.

    Article  Google Scholar 

  3. Revised criteria of diagnosis of celiac disease. Report of working group of European Society of Pediatric Gastroenterology and Nutrition. Arch Dis Child. 1990;65:909–911.

    Article  Google Scholar 

  4. Mubarak A, Wolters VM, Gmelig-Meyling FH, Ten Kate FJ, Houwen RH. Tissue transglutaminase levels above 100 U/ml and celiac disease: a prospective study. World J World J Gastroenterol. 2012;18:4399–4403.

    Article  CAS  PubMed  Google Scholar 

  5. Alessio MG, Tonutti E, Brusca I, et al. Correlation between IgA tissue transglutaminase antibody ratio and histological finding in celiac disease. J Pediatr Gastroenterol Nutr. 2012;55:44–49.

    Article  CAS  PubMed  Google Scholar 

  6. Hill PG, Holmes GK. Celiac disease: a biopsy is not always necessary for diagnosis. Aliment Pharmacol Ther. 2008;27:572–577.

    Article  CAS  PubMed  Google Scholar 

  7. Donaldson MR, Firth SD, Wimpee H, et al. Duodenal histology correlates with tissue transglutaminase and endomysial antibody levels in pediatric celiac disease. Clin Gastroenterol Hepatol. 2007;5:567–573.

    Article  CAS  PubMed  Google Scholar 

  8. Webb C, Norström F, Myléus A, et al. Celiac disease can be predicted by high levels of anti-tissue transglutaminase antibodies in population-based screening. J Pediatr Gastroenterol Nutr. 2015;60:787–791.

    Article  CAS  PubMed  Google Scholar 

  9. Husby S, Koletzko S, Korponay-Szabó IR, et al. European society for pediatric gastroenterology, hepatology, and nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr. 2012;54:136–160.

    Article  CAS  PubMed  Google Scholar 

  10. Hasegawa K, Ahn J, Brown MA, et al. Underuse of guideline recommended long-term asthma management in children hospitalized to the intensive care unit: a multicenter observational study. Ann Allergy Asthma Immunol. 2015;115:10-6.e1.

    Article  PubMed  Google Scholar 

  11. Silvester JA, Rashid M. Long-term management of patients with celiac disease: current practices of gastroenterologists in Canada. Can J Gastroenterol. 2010;24:499–509.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Rashid M. Diagnosing celiac disease with a positive serological test and without intestinal biopsy. Pediatrics. 2005;116:1054–1055.

    Article  PubMed  Google Scholar 

  13. Hill ID, Horvath K. Nonbiopsy diagnosis of celiac disease: are we nearly there yet?. J Pediatr Gastroenterol Nutr. 2012;54:310–311.

    Article  PubMed  Google Scholar 

  14. Donate E, Ramos JM, Sanchez-Valverde F, et al. Ribes-Koninckx C on behalf of the SEGHNP working group on celiac disease. J Pediatr Gastroenterol Nutr. 2016;62:284–291.

    Article  Google Scholar 

  15. Green PH, Jabri B. Celiac disease. Ann Rev Med. 2006;57:207–221.

    Article  CAS  PubMed  Google Scholar 

  16. Barker CC, Mitton C, Jevon G, Mock T. Can tissue transglutaminase antibody titers replace small-bowel biopsy to diagnose celiac disease in select pediatric populations? Pediatrics. 2005;115:1341–1346.

    Article  PubMed  Google Scholar 

  17. Collin P, Kaukinen K, Vogelsang H, et al. Antiendomysial and antihuman recombinant tissue transglutaminase antibodies in the diagnosis of coeliac disease: a biopsy-proven European multicentre study. Eur J Gastroenterol Hepatol. 2005;17:85–91.

    Article  CAS  PubMed  Google Scholar 

  18. Donaldson MR, Book LS, Leiferman KM, Zone JJ, Neuhausen SL. Strongly positive tissue transglutaminase antibodies are associated with Marsh 3 histopathology in adult and pediatric. J Clin Gastroenterol. 2008;42:256–260

    CAS  PubMed  Google Scholar 

  19. Gidrewicz D, Potter K, Trevenen CL, Lyon M, Butzner JD. Evaluation of the ESPGHAN celiac guidelines in a North American pediatric population. Am J Gastroenterol. 2015;110:760–767.

    Article  CAS  PubMed  Google Scholar 

  20. Ediger TR, Hill ID. Celiac disease. Pediatr Rev. 2014;35:409–415.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Gastroenterology, Joan C Edwards Medical School, Marshall University, 1600 Medical Center Drive, Suite 3500, Huntington, WV, 25701, USA

    Yoram Elitsur & Deborah L. Preston

  2. Division of Pediatric Gastroenterology, Montreal Children’s Hospital, McGill University Health Center, McGill University, 1001 Boulevard Décarie, Montreal, QC, H4A 3J1, Canada

    Terry Sigman

  3. Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD, 21201-1559, USA

    Runa Watkins & Elaine L. Leonard Puppa

  4. Department of Pediatrics, Section of Gastroenterology and Hepatology, Yale University, 333 Cedar Street, PO Box 208064, New Haven, CT, 06520-8064, USA

    Anthony F. Porto & Elsie J. Foglio

  5. Pediatric Gastroenterology, 20 York St., New Haven, CT, 06510-3220, USA

    Elsie J. Foglio

Authors
  1. Yoram Elitsur
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Terry Sigman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Runa Watkins
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anthony F. Porto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elaine L. Leonard Puppa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elsie J. Foglio
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Deborah L. Preston
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoram Elitsur.

Ethics declarations

Conflict of interest

This study was self-funded and the authors have no financial disclosures to make regarding this body of work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elitsur, Y., Sigman, T., Watkins, R. et al. Tissue Transglutaminase Levels Are Not Sufficient to Diagnose Celiac Disease in North American Practices Without Intestinal Biopsies. Dig Dis Sci 62, 175–179 (2017). https://doi.org/10.1007/s10620-016-4354-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-016-4354-4

Keywords

Search

Navigation