The anti-deamidated gliadin peptide antibodies unmask celiac disease in small children with chronic diarrhoea.
OBJECTIVE
To assess the usefulness of a new class of antibodies, the anti-deamidated gliadin peptides, in the diagnostic approach to children less than 2 years with suspected celiac disease.


METHODS
We investigated 40 children (median age: 16.8 months; age range: 4-24 months), with symptoms and signs of chronic enteropathy and high serum levels of conventional anti-gliadin antibodies, but normal values of anti-transglutaminase and anti-endomysial antibodies; all underwent measurement of anti-deamidated gliadin peptides serum levels, upper gastrointestinal endoscopy with biopsies and HLA typing; 40 subjects served as controls.


RESULTS
In 29 patients (group A) serum levels of anti-deamidated gliadin peptides were normal and duodenal histology showed a spectrum of abnormalities ranging from mucosal inflammatory infiltrates to villous damage (in almost all cases compatible with Marsh 1-to-2 lesions). All improved on a cow's and soy milk free diet containing gluten. In 11 patients (group B) there were high serum levels of anti-deamidated gliadin peptides and histology showed features suggestive of celiac disease (Marsh 2-to-3 lesions) in all; furthermore, human leucocyte antigen typing was consistent with a celiac disease genetic pattern in all. Group B patients significantly improved on a gluten free diet containing cow's and soy milk proteins. None of the control group was anti-deamidated gliadin peptides positive.


CONCLUSIONS
In children younger than 2 years with signs of chronic enteropathy and normal values of classical serum markers of celiac disease, the latter can be predicted by high serum levels of anti-deamidated gliadin peptides.
Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
Maria
M
Barbato
Giulia
G
Maiella
Chiara
C
Di Camillo
Sofia
S
Guida
Francesco
F
Valitutti
Ginevra
G
Lastrucci
Fabrizio
F
Mainiero
Salvatore
S
Cucchiara
D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy / Q000276:immunology; D002675:Child, Preschool; D002908:Chronic Disease; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000209:etiology*; D005260:Female; D005903:Gliadin / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007074:Immunoglobulin G / Q000097:blood*; D007223:Infant; D008297:Male; D010446:Peptide Fragments / Q000276:immunology
D015415:Biomarkers; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D010446:Peptide Fragments; D005903:Gliadin