title: Follow-up of pediatric celiac disease: value of antibodies in predicting mucosal healing, a prospective cohort study.
abstract: BACKGROUND
  In diagnosing celiac disease (CD), serological tests are highly valuable. However, their role in following up children with CD after prescription of a gluten-free diet is unclear. This study aimed to compare the performance of antibody tests in predicting small-intestinal mucosal status in diagnosis vs. follow-up of pediatric CD.
  
  
  METHODS
  We conducted a prospective cohort study at a tertiary-care center. 148 children underwent esophohagogastroduodenoscopy with biopsies either for symptoms ± positive CD antibodies (group A; n = 95) or following up CD diagnosed ≥ 1 year before study enrollment (group B; n = 53). Using biopsy (Marsh ≥ 2) as the criterion standard, areas under ROC curves (AUCs) and likelihood-ratios were calculated to estimate the performance of antibody tests against tissue transglutaminase (TG2), deamidated gliadin peptide (DGP) and endomysium (EMA).
  
  
  RESULTS
  AUCs were higher when tests were used for CD diagnosis vs. follow-up: 1 vs. 0.86 (P = 0.100) for TG2-IgA, 0.85 vs. 0.74 (P = 0.421) for TG2-IgG, 0.97 vs. 0.61 (P = 0.004) for DPG-IgA, and 0.99 vs. 0.88 (P = 0.053) for DPG-IgG, respectively. Empirical power was 85% for the DPG-IgA comparison, and on average 33% (range 13-43) for the non-significant comparisons. Among group B children, 88.7% showed mucosal healing (median 2.2 years after primary diagnosis). Only the negative likelihood-ratio of EMA was low enough (0.097) to effectively rule out persistent mucosal injury. However, out of 12 EMA-positive children with mucosal healing, 9 subsequently turned EMA-negative.
  
  
  CONCLUSIONS
  Among the CD antibodies examined, negative EMA most reliably predict mucosal healing. In general, however, antibody tests, especially DPG-IgA, are of limited value in predicting the mucosal status in the early years post-diagnosis but may be sufficient after a longer period of time.
authors: Edith
authors: E
authors: Vécsei
authors: Stephanie
authors: S
authors: Steinwendner
authors: Hubert
authors: H
authors: Kogler
authors: Albina
authors: A
authors: Innerhofer
authors: Karin
authors: K
authors: Hammer
authors: Oskar A
authors: OA
authors: Haas
authors: Gabriele
authors: G
authors: Amann
authors: Andreas
authors: A
authors: Chott
authors: Harald
authors: H
authors: Vogelsang
authors: Regine
authors: R
authors: Schoenlechner
authors: Wolfgang
authors: W
authors: Huf
authors: Department of Pediatrics, Pediatric Gastroenterology, St, Anna Children's Hospital, Medical University Vienna, Kinderspitalgasse 6, 1090 Vienna, Austria. andreas.vecsei@stanna.at.
authors: Andreas
authors: A
authors: Vécsei
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002446:Celiac Disease / Q000097:blood* / Q000178:diet therapy / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D055050:Diet, Gluten-Free; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D019204:GTP-Binding Proteins; D005903:Gliadin / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007074:Immunoglobulin G / Q000097:blood*; D007413:Intestinal Mucosa / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D010446:Peptide Fragments / Q000276:immunology; D011446:Prospective Studies; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012680:Sensitivity and Specificity; D011503:Transglutaminases / Q000276:immunology*; D014945:Wound Healing; D055815:Young Adult
chemical_list: D007070:Immunoglobulin A; D007074:Immunoglobulin G; D010446:Peptide Fragments; D005903:Gliadin; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins