title: Celiac disease can be predicted by high levels of anti-tissue transglutaminase antibodies in population-based screening.
abstract: OBJECTIVE
  The aim of the present study was to evaluate any potential correlation between anti-tissue transglutaminase antibodies of type immunoglobulin A (tTG-IgA) and the degree of gluten-induced enteropathy in children participating in a screening study for celiac disease (CD) and to assess to what extent the revised European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines cover this group of patients.
  
  
  METHODS
  The present study is a substudy of a cross-sectional CD screening study, Exploring the Iceberg of Celiacs in Sweden, a 2-phased study performed during 2005 to 2006 and 2009 to 2010. The 13,279 participating children had a blood test obtained, and those with positive tTG-IgA were recommended a small intestinal biopsy. The tTG-IgA levels at the time of biopsy were compared with those at the assessment of the biopsy.
  
  
  RESULTS
  There were 267 children included, of whom 230 were diagnosed as having CD. Of all of the children, 67 children had low tTG-IgA levels (<5 U/mL), of whom 55% had Marsh 3 lesions. All of the children with tTG-IgA levels exceeding 10 times the upper limit of normal values of 5 U/mL, that is, 50 U/mL, were diagnosed as having CD. Lowering the cutoff to 3 U/mL, all but 1 child with 30 U/mL got CD diagnosis.
  
  
  CONCLUSIONS
  By adopting the revised ESPGHAN criteria, biopsies could have been omitted in one-fourth of all of the patients. Our results indicate that the criteria may be useful even in screened children. Further studies are needed to confirm whether the 2012 ESPGHAN guidelines should be revised to also apply to the populations being screened.
authors.affiliation: *Department of Pediatrics, Clinical Sciences, Skåne University Hospital, Lund University, Lund †Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå ‡Department of Pathology and Cytology, Aleris Medilab, Täby §Pediatric Clinic, Norrköping Hospital, Norrköping ¶Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
authors.forename: Charlotta
authors.initials: C
authors.lastname: Webb
authors.forename: Fredrik
authors.initials: F
authors.lastname: Norström
authors.forename: Anna
authors.initials: A
authors.lastname: Myléus
authors.forename: Anneli
authors.initials: A
authors.lastname: Ivarsson
authors.forename: Britta
authors.initials: B
authors.lastname: Halvarsson
authors.forename: Lotta
authors.initials: L
authors.lastname: Högberg
authors.forename: Carina
authors.initials: C
authors.lastname: Lagerqvist
authors.forename: Anna
authors.initials: A
authors.lastname: Rosén
authors.forename: Olof
authors.initials: O
authors.lastname: Sandström
authors.forename: Lars
authors.initials: L
authors.lastname: Stenhammar
authors.forename: Annelie
authors.initials: A
authors.lastname: Carlsson
mesh_terms: D000293:Adolescent; D001323:Autoantibodies / Q000097:blood*; D001706:Biopsy / Q000379:methods; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D013548:Sweden; D011503:Transglutaminases / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D007070:Immunoglobulin A; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins