title: Can celiac serology alone be used as a marker of duodenal mucosal recovery in children with celiac disease on a gluten-free diet?
abstract: OBJECTIVE
  Assessment of treatment response in children with celiac disease (CD) after commencing a strict gluten-free diet (GFD) is generally based on the resolution of clinical features and normalization of serology. Recent adult studies have shown that serologic markers do not correlate with mucosal recovery. We aimed (i) to determine whether anti-tissue transglutaminase immunoglobulin (Ig)A (tTG) and anti-deamidated gliadin peptide IgG (DGP) antibodies are sensitive and specific markers of mucosal recovery in children with CD on a GFD for at least 12 months, and (ii) to determine whether a validated dietary questionnaire of compliance can identify patients with mucosal recovery.
  
  
  METHODS
  A total of 150 children with biopsy-proven CD were prospectively evaluated with duodenal biopsies at ≥12 months on GFD, paired with repeat tTG and DGP serology. The biopsies were reviewed in a blinded manner by two histopathologists and graded by Marsh criteria. A validated questionnaire of dietary compliance was also administered.
  
  
  RESULTS
  Of 150 children recruited, 27 (18%) had positive serology, 97 (65%) had negative serology, and 26 (17%) had equivocal serology. Of the 97 children with negative serology, none had Marsh type 3 enteropathy. Of the 27 patients with positive serology, only 6 had Marsh type 3 changes. The sensitivity and specificity of serology as a marker of significant mucosal pathology was 75 and 85%, respectively, with a positive predictive value of 22% but a negative predictive value of 98%. Of the 129 (86%) questionnaires completed, 88% reported good or excellent compliance with a GFD (negative predictive value 97%).
  
  
  CONCLUSIONS
  This study suggests that follow-up using two serological tests in children with CD on a GFD may obviate the need for repeat mucosal biopsy in the majority of patients. A standardized dietary questionnaire may be useful in identifying patients who require further evaluation.
authors: 1] Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia [2] Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
authors: Elizabeth G
authors: EG
authors: Bannister
authors: 1] Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia [2] Murdoch Children's Research Institute, Parkville, Victoria, Australia.
authors: Donald J
authors: DJ
authors: Cameron
authors: Department of Anatomical Pathology, Royal Children's Hospital, Parkville, Victoria, Australia.
authors: Jessica
authors: J
authors: Ng
authors: 1] Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia [2] Department of Anatomical Pathology, Royal Children's Hospital, Parkville, Victoria, Australia.
authors: Chung W
authors: CW
authors: Chow
authors: 1] Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia [2] Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia [3] Murdoch Children's Research Institute, Parkville, Victoria, Australia.
authors: Mark R
authors: MR
authors: Oliver
authors: 1] Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia [2] Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia [3] Murdoch Children's Research Institute, Parkville, Victoria, Australia.
authors: George
authors: G
authors: Alex
authors: 1] Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia [2] Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
authors: Anthony G
authors: AG
authors: Catto-Smith
authors: 1] Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia [2] Murdoch Children's Research Institute, Parkville, Victoria, Australia.
authors: Ralf G
authors: RG
authors: Heine
authors: Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia.
authors: Annette
authors: A
authors: Webb
authors: Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia.
authors: Kathleen
authors: K
authors: McGrath
authors: Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia.
authors: Diane
authors: D
authors: Simpson
authors: 1] Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia [2] Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia [3] Murdoch Children's Research Institute, Parkville, Victoria, Australia.
authors: Winita
authors: W
authors: Hardikar
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002446:Celiac Disease / Q000178:diet therapy / Q000276:immunology* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000473:pathology*; D005260:Female; D019204:GTP-Binding Proteins; D005903:Gliadin / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007074:Immunoglobulin G / Q000097:blood*; D007223:Infant; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D010349:Patient Compliance; D011237:Predictive Value of Tests; D011446:Prospective Studies; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011795:Surveys and Questionnaires; D011503:Transglutaminases / Q000276:immunology*
chemical_list: D015415:Biomarkers; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D005903:Gliadin; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins