title: Value of IgA tTG in Predicting Mucosal Recovery in Children With Celiac Disease on a Gluten-Free Diet.
abstract: Our objective was to determine the rate of mucosal recovery in pediatric patients with celiac disease on a gluten-free diet. We also sought to determine whether immunoglobulin A tissue transglutaminase (tTG) correlates with mucosal damage at the time of a repeat endoscopy with duodenal biopsy in these patients.
  
  
  
  We performed a retrospective chart review of 103 pediatric patients, younger than 21 years, with a diagnosis of celiac disease defined as Marsh 3 histology, and who underwent a repeat endoscopy with duodenal biopsy at least 12 months after initiating a gluten-free diet.
  
  
  
  We found that 19% of pediatric patients treated with a gluten-free diet had persistent enteropathy. At the time of the repeat biopsy, tTG was elevated in 43% of cases with persistent enteropathy and 32% of cases in which there was mucosal recovery. Overall the positive predictive value of the autoantibody tTG was 25% and the negative predictive value was 83% in patients on a gluten-free diet for a median of 2.4 years.
  
  
  
  Nearly 1 in 5 children with celiac disease in our population had persistent enteropathy despite maintaining a gluten-free diet and immunoglobulin A tTG was not an accurate marker of mucosal recovery. Neither the presence of symptoms nor positive serology were predictive of a patient's histology at the time of repeat biopsy. These findings suggest a revisitation of monitring and management criteria of celiac disease in childhood.
authors.affiliation: *Department of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children†Celiac Research Program, Harvard Medical School‡Division of Gastroenterology and Nutrition§Clinical Research Center, Boston Children's Hospital||Department of Medicine, Massachusetts General Hospital, Boston, MA¶University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Leonard
authors.forename: Dascha C
authors.initials: DC
authors.lastname: Weir
authors.forename: Maya
authors.initials: M
authors.lastname: DeGroote
authors.forename: Paul D
authors.initials: PD
authors.lastname: Mitchell
authors.forename: Prashant
authors.initials: P
authors.lastname: Singh
authors.forename: Jocelyn A
authors.initials: JA
authors.lastname: Silvester
authors.forename: Alan M
authors.initials: AM
authors.lastname: Leichtner
authors.forename: Alessio
authors.initials: A
authors.lastname: Fasano
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis / Q000178:diet therapy* / Q000276:immunology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D055050:Diet, Gluten-Free; D004384:Duodenoscopy; D004386:Duodenum / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D019204:GTP-Binding Proteins / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007223:Infant; D007231:Infant, Newborn; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D011237:Predictive Value of Tests; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012189:Retrospective Studies; D011503:Transglutaminases / Q000276:immunology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007070:Immunoglobulin A; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins