title: Duodenal biopsy may be avoided when high transglutaminase antibody titers are present.
abstract: OBJECTIVE
  To evaluate the predictive value of tissue transglutaminase (tTG) antibodies for villous atrophy in adult and pediatric populations to determine if duodenal biopsy can be avoided.
  
  
  METHODS
  A total of 324 patients with celiac disease (CD; 97 children and 227 adults) were recruited prospectively at two tertiary centers. Human IgA class anti-tTG antibody measurement and upper gastrointestinal endoscopy were performed at diagnosis. A second biopsy was performed in 40 asymptomatic adults on a gluten-free diet (GFD) and with normal tTG levels.
  
  
  RESULTS
  Adults showed less severe histopathology (26% vs 63%, P < 0.0001) and lower tTG antibody titers than children. Levels of tTG antibody correlated with Marsh type in both populations (r = 0.661, P < 0.0001). Multiple logistic regression revealed that only tTG antibody was an independent predictor for Marsh type 3 lesions, but clinical presentation type and age were not. A cut-off point of 30 U tTG antibody yielded the highest area under the receiver operating characteristic curve (0.854). Based on the predictive value of this cut-off point, up to 95% of children and 53% of adults would be correctly diagnosed without biopsy. Despite GFDs and decreased tTG antibody levels, 25% of the adults did not recover from villous atrophy during the second year after diagnosis.
  
  
  CONCLUSIONS
  Strongly positive tTG antibody titers might be sufficient for CD diagnosis in children. However, duodenal biopsy cannot be avoided in adults because disease presentation and monitoring are different.
authors.affiliation: Department of Gastroenterology, Hospital de León, León, Spain. svivasa@medynet.com
authors.forename: Santiago
authors.initials: S
authors.lastname: Vivas
authors.forename: Jose G
authors.initials: JG
authors.lastname: Ruiz de Morales
authors.forename: Sabino
authors.initials: S
authors.lastname: Riestra
authors.forename: Laura
authors.initials: L
authors.lastname: Arias
authors.forename: Dolores
authors.initials: D
authors.lastname: Fuentes
authors.forename: Noemi
authors.initials: N
authors.lastname: Alvarez
authors.forename: Sara
authors.initials: S
authors.lastname: Calleja
authors.forename: Mercedes
authors.initials: M
authors.lastname: Hernando
authors.forename: Blanca
authors.initials: B
authors.lastname: Herrero
authors.forename: Javier
authors.initials: J
authors.lastname: Casqueiro
authors.forename: Luis
authors.initials: L
authors.lastname: Rodrigo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000097:blood; D001706:Biopsy / Q000592:standards / Q000706:statistics & numerical data*; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000473:pathology*; D004724:Endoscopy / Q000379:methods; D005260:Female; D005762:Gastroenterology / Q000379:methods* / Q000592:standards*; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology; D007223:Infant; D008297:Male; D008875:Middle Aged; D011503:Transglutaminases / Q000097:blood* / Q000276:immunology
chemical_list: D000906:Antibodies; D007070:Immunoglobulin A; D011503:Transglutaminases