title: Prospective antibody case finding of coeliac disease in type-1 diabetes children: need of biopsy revisited.
abstract: OBJECTIVE
  To evaluate whether coeliac disease (CD) can be diagnosed by measuring autoantibodies without small-intestinal mucosal biopsies in children with type 1 diabetes.
  
  
  METHODS
  Case finding of CD was undertaken in 181 consecutive IgA-competent children with type 1 diabetes using transglutaminase 2 (TG2) and endomysial IgA antibody (EMA) tests in serum and the rapid point of care test in fingertip whole-blood sample. Endoscopy with intestinal biopsies was recommended for patients with high TG2-IgA titres (>96 U) and in children with lower positive tests if either the EMA test or the rapid point of care test was additionally positive. The duodenal mucosal biopsies were graded according to the Marsh classification.
  
  
  RESULTS
  The TG2-IgA test had a 15.5% and the EMA test a 6.0% seropositivity. All seven biopsied high-titre TG2-IgA-positive children were symptom free and found to have CD (Marsh 3 type lesion). These patients were also positive for EMA and in the rapid point of care test. Lower titre TG2-IgA-positive children had histological Marsh 1 to 3a lesions.
  
  
  CONCLUSIONS
  None of the type 1 diabetes children with high TG2-IgA titres would have needed endoscopy with duodenal biopsies to reach a CD diagnosis. Lower TG2-IgA-positive patients need to be biopsied.
authors.affiliation: University of Medicine and Pharmacy Carol Davila, Bucharest, Romania. alina.popp@uta.fi
authors.forename: Alina
authors.initials: A
authors.lastname: Popp
authors.forename: Mihaela
authors.initials: M
authors.lastname: Mihu
authors.forename: Mihai
authors.initials: M
authors.lastname: Munteanu
authors.forename: Adina
authors.initials: A
authors.lastname: Ene
authors.forename: Monica
authors.initials: M
authors.lastname: Dutescu
authors.forename: Florin
authors.initials: F
authors.lastname: Colcer
authors.forename: Diana
authors.initials: D
authors.lastname: Raducanu
authors.forename: Kaija
authors.initials: K
authors.lastname: Laurila
authors.forename: Ioana
authors.initials: I
authors.lastname: Anca
authors.forename: Markku
authors.initials: M
authors.lastname: Mäki
mesh_terms: D000293:Adolescent; D001323:Autoantibodies / Q000097:blood*; D001706:Biopsy; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000276:immunology; D004386:Duodenum / Q000473:pathology*; D004724:Endoscopy; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology*; D007223:Infant; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D018579:Patient Selection; D011446:Prospective Studies; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D007070:Immunoglobulin A; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins