Anti-tissue transglutaminase antibodies in the follow-up of adult coeliac disease.
BACKGROUND
The detection of auto antibodies directed against tissue transglutaminase (anti-tTG antibodies) has a well-established role in the diagnosis of coeliac disease, but the value of these antibodies in long-term follow-up is controversial.


OBJECTIVE
To determine if serial anti-tTG antibody measurements could confirm adherence to a gluten-free diet (GFD) and identify patients at risk of disease complications.


METHODS
In a 54-month cohort follow-up study, 182 adult patients were assessed. Data recorded included self-assessment of GFD adherence; anti-tTG antibody concentration and serum ferritin, vitamin B12 and folate. Where available, bone mineral density (BMD) and duodenal histology data were retrieved.


RESULTS
Persistently elevated anti-tTG antibody levels were significantly associated with abnormal duodenal histology (P < 0.001), low ferritin (P < 0.01) and poor adherence to the GFD (P < 0.001). The specificity was >85% while the sensitivity was 39-60%. Anti-tTG antibody concentrations fell rapidly following successful initiation of a GFD, and maintenance of normalization identified those who continued to be adherent to the diet.


CONCLUSIONS
This study supports a strategy of using anti-tTG antibody concentrations to monitor newly diagnosed and established patients with coeliac disease, and to target dietetic intervention to reduce the risk of complication.
Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
C R
CR
Dipper
S
S
Maitra
R
R
Thomas
C A
CA
Lamb
A P C
AP
McLean-Tooke
R
R
Ward
D
D
Smith
G
G
Spickett
J C
JC
Mansfield
D000293:Adolescent; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood / Q000276:immunology*; D015519:Bone Density; D002446:Celiac Disease / Q000150:complications / Q000178:diet therapy* / Q000276:immunology; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000033:anatomy & histology; D005260:Female; D005293:Ferritins; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012307:Risk Factors; D011503:Transglutaminases / Q000276:immunology*; D014805:Vitamin B 12; D055815:Young Adult
D000906:Antibodies; D001323:Autoantibodies; D005293:Ferritins; D011503:Transglutaminases; D014805:Vitamin B 12