title: Correlation of tissue transglutaminase antibody with duodenal histologic marsh grading.
abstract: BACKGROUND Recent guidelines have proposed that there is a correlation between tissue transglutaminase (tTG) antibody titers and degrees of duodenal biopsy, and that duodenal biopsy can be omitted in some patients with high levels of tTG antibody. Using data of registered patients in a gastrointestinal clinic we aimed to assess the correlation between tissue transglutaminase antibody with duodenal histologic Marsh grading in Iranian patients with celiac disease. METHODS We retrospectively reviewed hospital files of registered patients in the gastrointestinal clinic of Firoozgar Hospital, Tehran, Iran. Demographic, laboratory, and histology data of those who had tTG titer and pathology reports of duodenal biopsy based on the modified Marsh classification were extracted and used for the study. RESULTS 159 patients with available tTG titer and pathology reports were enrolled in our study. Mean ±SD of the patients was 35.6±15.2 and 100 (62.9%) of them were women. 133 out of 153 patients had villous atrophy (Marsh IIIa-IIIc). Anemia was the most common sign and bloating, abdominal pain, and diarrhea were the first three common symptoms in these patients. Mean tTG titers was significantly higher in patients graded as Marsh III (p for trend=0.003). Our results showed that tTG titer more than 9 folds higher than the kit's cut-off value was about 97.2% sensitive for Marsh II and more duodenal damage. CONCLUSION There was a correlation between tTG titers and degrees of duodenal damage in patients with celiac disease. Duodenal biopsy is not always necessary for diagnosing celiac disease and when tTG level is more than 9 folds higher than the manufacture's recommended cut-off value it can be avoided. Meanwhile small intestinal biopsy should always be considered in case of high clinical suspicion, regardless of the results of serologic testing.
authors.affiliation: Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Atieh
authors.initials: A
authors.lastname: Rahmati
authors.affiliation: Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran ; Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Ramin
authors.initials: R
authors.lastname: Shakeri
authors.affiliation: Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Masoudreza
authors.initials: M
authors.lastname: Sohrabi
authors.affiliation: Department of Community Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Abbass
authors.initials: A
authors.lastname: Alipour
authors.affiliation: Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Amirhossein
authors.initials: A
authors.lastname: Boghratian
authors.affiliation: Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Massomeh
authors.initials: M
authors.lastname: Setareh
authors.affiliation: Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Farhad
authors.initials: F
authors.lastname: Zamani
keywords: Celiac disease; Histology; Marsh Grading; Tissue Transglutaminase Antibody
references.citation: Arch Intern Med. 2003 Feb 10;163(3):286-92
references.pmid: 12578508
references.citation: Clin Gastroenterol Hepatol. 2007 May;5(5):567-73
references.pmid: 17428743
references.citation: J Clin Gastroenterol. 2008 Mar;42(3):256-60
references.pmid: 18223500
references.citation: Nat Med. 1997 Jul;3(7):797-801
references.pmid: 9212111
references.citation: Ann N Y Acad Sci. 1998 Nov 17;859:121-6
references.pmid: 9928375
references.citation: Dig Liver Dis. 2012 Apr;44(4):280-5
references.pmid: 22119616
references.citation: World J Gastroenterol. 2008 Dec 28;14(48):7381-5
references.pmid: 19109873
references.citation: BMC Gastroenterol. 2009 Jun 17;9:44
references.pmid: 19534771
references.citation: N Engl J Med. 2002 Jan 17;346(3):180-8
references.pmid: 11796853
references.citation: World J Gastroenterol. 2009 Oct 14;15(38):4775-80
references.pmid: 19824110
references.citation: Gastroenterology. 2005 Apr;128(4 Suppl 1):S68-73
references.pmid: 15825129
references.citation: Pediatrics. 2005 May;115(5):1341-6
references.pmid: 15867045
references.citation: Eur J Gastroenterol Hepatol. 2001 Jun;13(6):659-65
references.pmid: 11434591
references.citation: J Pediatr Gastroenterol Nutr. 2012 Jul;55(1):44-9
references.pmid: 22197946
references.citation: World J Gastroenterol. 2012 Aug 28;18(32):4399-403
references.pmid: 22969205
references.citation: J Clin Gastroenterol. 2003 Mar;36(3):219-21
references.pmid: 12590232
references.citation: J Pediatr Gastroenterol Nutr. 2012 Jan;54(1):136-60
references.pmid: 22197856
references.citation: Eur J Gastroenterol Hepatol. 2006 Nov;18(11):1181-6
references.pmid: 17033439
references.citation: Arch Iran Med. 2013 Feb;16(2):78-82
references.pmid: 23360628
references.citation: Am J Gastroenterol. 1999 Apr;94(4):888-94
references.pmid: 10201452
references.citation: Pediatr Res. 2002 Jun;51(6):700-5
references.pmid: 12032264
references.citation: Gastroenterology. 1998 Dec;115(6):1317-21
references.pmid: 9834256
references.citation: N Engl J Med. 2007 Oct 25;357(17):1731-43
references.pmid: 17960014
references.citation: Aliment Pharmacol Ther. 2013 Aug;38(3):226-45
references.pmid: 23782240
references.citation: J Clin Gastroenterol. 2009 Aug;43(7):622-6
references.pmid: 19238095
references.citation: Med J Aust. 2001 Sep 3;175(5):247-50
references.pmid: 11587254