title: [Prediction of intestinal histological lesions in paediatric patients with coeliac disease].
abstract: BACKGROUND
  Serological markers are of great interest in coeliac disease (CD), although intestinal biopsy is still the gold standard for establishing the diagnosis. Tissue transglutaminase IgA antibodies (AATGt-IgA) and antiendomysial antibodies IgA (AAE-IgA) are closely correlated to intestinal damage observed in biopsies. Villous atrophy (Marsh 3) plays a major role in CD diagnosis. Marsh 2 stage (crypt hyperplasia) as a CD marker is still under debate.
  
  
  OBJECTIVE
  To ascertain an AATGt-IgA level that corresponds to a positive predictive value (PPV) of 100% for a histological CD diagnosis.
  
  
  METHODS
  A series of 120 patients younger than 14 years, non- IgA deficient, who underwent an intestinal biopsy and were positive for both serological markers (AATGt-IgA and AAE-IgA). For AATGt-IgA, according to the manufacturer's recommendations, a value greater than 16 IU/mL is considered as a positive value. The PPV of AATGt was determined for different cut-off points.
  
  
  RESULTS
  The histological findings distribution is directly correlated to the AATGt-IgA cut-off point. When the cut-off point is set above 7.5-10.6 times the commercial reference value, there is a 2.1% of Marsh 2 lessions and 93.4% of Marsh 3; above 10.6 times the reference value, all biopsies where Marsh 3 (100%). The PPV that considers Marsh 3 is (93.4%). The PPV, for considering Marsh 3 is low (55%) when AATGt-IgA serology is positive with levels between 16 and 67 IU/ml (1-4.2 times the cut-off point) and a higher value (92%) for concentrations between 68 and 118 IU/ml (4.3-7.4 times) and for cases with 69-170 IU/ml (7.5-10.6 times); above 170 IU/ml (>10.6 times) PPV is 100%.
  
  
  CONCLUSIONS
  The use of values higher than the recommended cut-off point must logically improve specificity and PPV. In 31.6% patients positive for AATGt-IgA and AAE-IgA (38/120) it would have been possible to diagnose the disease without intestinal biopsy as of the PPV was 100%. It is not possible to standardise results as there are different commercial kits with variable cut-off points, so we must be cautious when setting recommendations based on AATGt-IgA.
authors.affiliation: Unidad de Gastroenterología, Hepatología y Nutrición Infantil, Hospital Materno-Infantil Carlos Haya, Málaga, España.
authors.forename: C
authors.initials: C
authors.lastname: Sierra Salinas
authors.forename: J
authors.initials: J
authors.lastname: Blasco Alonso
authors.forename: V M
authors.initials: VM
authors.lastname: Navas López
authors.forename: M I
authors.initials: MI
authors.lastname: Vicioso
authors.forename: J
authors.initials: J
authors.lastname: Serrano Nieto
authors.forename: B
authors.initials: B
authors.lastname: Weil Lara
authors.forename: D Alfageme
authors.initials: DA
authors.lastname: Pérez de Las Vacas
authors.forename: A
authors.initials: A
authors.lastname: Barco Gálvez
mesh_terms: D000293:Adolescent; D002446:Celiac Disease / Q000097:blood* / Q000473:pathology*; D002648:Child; D019204:GTP-Binding Proteins / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007422:Intestines / Q000473:pathology*; D018485:Muscle Fibers, Skeletal / Q000276:immunology; D011237:Predictive Value of Tests; D011379:Prognosis; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012189:Retrospective Studies; D011503:Transglutaminases / Q000276:immunology
chemical_list: D007070:Immunoglobulin A; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins