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.
Dipper
C R
CR
Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Maitra
S
S
Thomas
R
R
Lamb
C A
CA
McLean-Tooke
A P C
AP
Ward
R
R
Smith
D
D
Spickett
G
G
Mansfield
J C
JC
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