title: Tissue Transglutaminase Levels Are Not Sufficient to Diagnose Celiac Disease in North American Practices Without Intestinal Biopsies.
abstract: Celiac serology is crucial for the diagnosis of celiac disease in children. The American guideline for celiac disease in children suggested that positive serology should be followed by confirmatory intestinal histology. The relationship between high tissue transglutaminase titers and celiac disease in children has not been well investigated in children from North America.
  
  
  
  In the present study, we investigated whether different tissue transglutaminase titers in symptomatic children could predict celiac disease without the confirmation of intestinal histology.
  
  
  
  Data from biopsy confirmed celiac children were collected from four different clinics in North America. Clinical, serological, histological, and follow-up data were collected. The accuracy rates of various tissue transglutaminase titers to predict celiac disease in children were calculated.
  
  
  
  The data from 240 children were calculated. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate of tissue transglutaminase titers at ≥10× upper limit of normal were 75.4, 48.8, 87.7, 29.0, and 70.8 %, respectively. Similar data were noted in the other tissue transglutaminase titers (≥3× upper limit of normal, >100 U/ml, or >100 U/ml and >10× upper limit of normal).
  
  
  
  The positive predictive value of tissue transglutaminase titers at ≥3× upper limit of normal or higher was too low to predict celiac disease in children. Our data suggested that in routine clinical practice, high titers of tissue transglutaminase are not sufficient to diagnose celiac disease in North American children without intestinal biopsies.
authors: Department of Pediatrics, Gastroenterology, Joan C Edwards Medical School, Marshall University, 1600 Medical Center Drive, Suite 3500, Huntington, WV, 25701, USA. elitsur@marshall.edu.
authors: Yoram
authors: 0000-0001-8831-6664
authors: Y
authors: Elitsur
authors: Division of Pediatric Gastroenterology, Montreal Children's Hospital, McGill University Health Center, McGill University, 1001 Boulevard Décarie, Montreal, QC, H4A 3J1, Canada.
authors: Terry
authors: T
authors: Sigman
authors: Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD, 21201-1559, USA.
authors: Runa
authors: R
authors: Watkins
authors: Department of Pediatrics, Section of Gastroenterology and Hepatology, Yale University, 333 Cedar Street, PO Box 208064, New Haven, CT, 06520-8064, USA.
authors: Anthony F
authors: AF
authors: Porto
authors: Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD, 21201-1559, USA.
authors: Elaine L
authors: EL
authors: Leonard Puppa
authors: Department of Pediatrics, Section of Gastroenterology and Hepatology, Yale University, 333 Cedar Street, PO Box 208064, New Haven, CT, 06520-8064, USA.|Pediatric Gastroenterology, 20 York St., New Haven, CT, 06510-3220, USA.
authors: Elsie J
authors: EJ
authors: Foglio
authors: Department of Pediatrics, Gastroenterology, Joan C Edwards Medical School, Marshall University, 1600 Medical Center Drive, Suite 3500, Huntington, WV, 25701, USA.
authors: Deborah L
authors: DL
authors: Preston
mesh_terms: D000293:Adolescent; D001323:Autoantibodies / Q000276:immunology*; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004386:Duodenum / Q000473:pathology*; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology*; D007223:Infant; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D009656:North America; D011237:Predictive Value of Tests; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D011503:Transglutaminases / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D007070:Immunoglobulin A; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins
keywords: Celiac; Pediatrics; Serology; Tissue transglutaminase IgA titers