Diagnostic value of duodenal antitissue transglutaminase antibodies in gluten-sensitive enteropathy.
BACKGROUND
In gluten-sensitive enteropathy, antitissue transglutaminase antibodies are synthesized in the duodenum.


OBJECTIVE
To compare the diagnostic yield of these autoantibodies in cultured duodenal biopsies, duodenal aspirate and serum.


METHODS
Patients (n = 315, 135 female, 180 male; age: 37.3 +/- 1.1 years) referred for duodenal biopsies, were recruited and HLA-DQ2/DQ8 haplotyped. Histological measurements were made from duodenal biopsies and cultured duodenal biopsies were used for antitissue transglutaminase antibodies analysis by enzyme-linked immunosorbent assay. Duodenal aspirate was collected in a subgroup of 81 patients. Patients were classified, according to their histology, response to a gluten-free diet and DQ2/DQ8 status, as definite, likely or nongluten-sensitive enteropathy.


RESULTS
Histology was normal in 59% of patients; 28% had lymphocytic enteritis, 1% had crypt hyperplasia and 13% showed atrophy. In Marsh III patients, there was complete agreement between duodenal and serological antitissue transglutaminase antibodies measurements. Marsh I patients showed a slight antitissue transglutaminase antibodies sensitivity improvement in cultured duodenal biopsy compared to serum in definite (22% vs. 19%) and likely gluten-sensitive enteropathy (20% vs. 14%) patients. Combined serum and cultured duodenal biopsy antitissue transglutaminase antibodies assessment increased serological sensitivity from 19% to 30% in Marsh I patients.


CONCLUSIONS
Duodenal antitissue transglutaminase antibodies detection improves serological determination sensitivity in Marsh I patients, providing diagnostic value and therapeutic impact.
Santaolalla
R
R
Department of Gastroenterology, Hospital Mútua de Terrassa, Fundació per la Recerca Mútua de Terrassa, Barcelona, Spain.
Fernández-Bañares
F
F
Rodríguez
R
R
Alsina
M
M
Rosinach
M
M
Mariné
M
M
Farré
C
C
Salas
A
A
Forné
M
M
Loras
C
C
Espinós
J
J
Viver
J M
JM
Esteve
M
M
D000328:Adult; D001323:Autoantibodies / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D002446:Celiac Disease / Q000175:diagnosis* / Q000276:immunology; D004386:Duodenum / Q000201:enzymology; D005260:Female; D006683:HLA-DQ Antigens / Q000276:immunology*; D006801:Humans; D008297:Male; D011503:Transglutaminases / Q000276:immunology*
D001323:Autoantibodies; D015415:Biomarkers; D006683:HLA-DQ Antigens; C053186:HLA-DQ2 antigen; D011503:Transglutaminases