Correlation of duodenal histology with tissue transglutaminase and endomysial antibody levels in pediatric celiac disease.
OBJECTIVE
IgA antibodies against tissue transglutaminase (TTGA) and endomysium (EMA) are sensitive and specific markers for celiac disease (CD). Data correlating TTGA and EMA levels with degree of villous atrophy are limited. We compared duodenal histopathology in pediatric CD patients with TTGA and EMA serologies, symptoms, height, and weight.


METHODS
We identified 117 pediatric patients retrospectively who had serologic testing for IgA TTGA and IgA EMA and duodenal biopsies graded by modified Marsh criteria as 0-3c. Data were analyzed with Spearman rank correlation and multinomial logistic regression.


RESULTS
IgA TTGA (r = .704, P < .001) and IgA EMA (r = 0.740, P < .001) correlated with intestinal villous atrophy in pediatric CD patients by Spearman rank correlation. Similar correlations were found in a subset of 23 patients younger than 3 years of age. Multinomial logistic regression revealed increased probability of Marsh 3a or greater changes with increasing TTGA or EMA levels. Strongly positive antibody levels (TTGA >100 units or EMA titer >1:1280) were highly specific (>98%) for Marsh 3a or greater lesions. Among symptoms, abdominal distention and diarrhea were associated with abnormal histology.


CONCLUSIONS
IgA TTGA and EMA levels correlate with duodenal villous atrophy in pediatric CD patients. IgA TTGA >100 or EMA >1:1280 were nearly always associated with CD histopathology. With further validation of this observation, strongly positive titers might be considered sufficient for diagnosis of pediatric patients at risk for CD. Symptoms, height, and weight are not reliable predictors of CD.
Donaldson
Matthew R
MR
Department of Dermatology, University of Utah, Salt Lake City, Utah, USA.
Firth
Sean D
SD
Wimpee
Holly
H
Leiferman
Kristin M
KM
Zone
John J
JJ
Horsley
Wyatt
W
O'Gorman
Molly A
MA
Jackson
W Daniel
WD
Neuhausen
Susan L
SL
Hull
Christopher M
CM
Book
Linda S
LS
D000293:Adolescent; D001827:Body Height; D001835:Body Weight; D002446:Celiac Disease / Q000097:blood* / Q000276:immunology / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003238:Connective Tissue / Q000276:immunology*; D004386:Duodenum / Q000473:pathology*; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D016015:Logistic Models; D008297:Male; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012189:Retrospective Studies; D011503:Transglutaminases / Q000276:immunology*
D007070:Immunoglobulin A; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins