title: Celiac disease screening assays for children younger than 3 years of age: the performance of three serological tests.
abstract: OBJECTIVE
  The optimum serological test for celiac disease (CD) in young children is not known. The objective of our study was to compare the performance of three serological tests (IgA + IgG DGP, IgA TTG, and IgA + IgG EMA) for children younger than 3 years of age.
  
  
  METHODS
  We identified all subjects younger than 3 years of age (n = 6,074) that were tested for CD serology and included those with biopsy data. Patients were classified as group 1 (n = 47): patients with confirmed CD or group 2 (n = 12): patients with normal biopsy findings.
  
  
  RESULTS
  There was statistically significant difference between group 1 and group 2 with regard to number of patients with positive IgA TTG (97.87% vs. 50%, P < 0.001), IgA + IgG DGP (100% vs. 77.78%, P = 0.007), and IgA + IgG EMA (95.65% vs. 9.09%, P < 0.001). There was a significantly positive correlation between Marsh-Oberhuber score on the small duodenal biopsies and all tests. Analysis of sensitivity and specificity showed that manufacturer's levels had high sensitivity for all tests (IgA TTG 97%, IgA + IgG DGP 100%, IgA + IgG EMA 96%), however specificity was low for IgA + IgG DGP (44%) and IgA TTG (50%) but not for IgA + IgG EMA (91%).
  
  
  CONCLUSIONS
  For children younger than 3 years of age, IgA + IgG EMA is highly sensitive and specific. Use of IgA + IgG DGP or IgA TTG as a single serological marker is insufficient for definite diagnosis of CD in this age group. Based on our results, it might be reasonable to postpone the biopsy for asymptomatic children with negative EMA.
authors.affiliation: Institute of Gastroenterology, Nutrition, and Liver Disease, Schneider Children's Medical Center of Israel, 14 Kaplan St, 49202 Petach Tikva, Israel.
authors.forename: Iva
authors.initials: I
authors.lastname: Hojsak
authors.forename: Yael
authors.initials: Y
authors.lastname: Mozer-Glassberg
authors.forename: Netta
authors.initials: N
authors.lastname: Segal Gilboa
authors.forename: Ronit
authors.initials: R
authors.lastname: Weinberger
authors.forename: Corina
authors.initials: C
authors.lastname: Hartman
authors.forename: Raanan
authors.initials: R
authors.lastname: Shamir
mesh_terms: D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis* / Q000276:immunology*; D002675:Child, Preschool; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology; D005903:Gliadin / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000379:methods*; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012680:Sensitivity and Specificity; D012698:Serologic Tests / Q000379:methods*; D011503:Transglutaminases / Q000276:immunology
chemical_list: D007070:Immunoglobulin A; D007074:Immunoglobulin G; D005903:Gliadin; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins