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. 2009 Oct 14;15(38):4775-80.
doi: 10.3748/wjg.15.4775.

Duodenal biopsy may be avoided when high transglutaminase antibody titers are present

Santiago Vivas  1 , Jose G Ruiz de Morales, Sabino Riestra, Laura Arias, Dolores Fuentes, Noemi Alvarez, Sara Calleja, Mercedes Hernando, Blanca Herrero, Javier Casqueiro, Luis Rodrigo
Affiliations

Duodenal biopsy may be avoided when high transglutaminase antibody titers are present

Santiago Vivas et al. World J Gastroenterol. .

Abstract

Aim: To evaluate the predictive value of tissue transglutaminase (tTG) antibodies for villous atrophy in adult and pediatric populations to determine if duodenal biopsy can be avoided.

Methods: A total of 324 patients with celiac disease (CD; 97 children and 227 adults) were recruited prospectively at two tertiary centers. Human IgA class anti-tTG antibody measurement and upper gastrointestinal endoscopy were performed at diagnosis. A second biopsy was performed in 40 asymptomatic adults on a gluten-free diet (GFD) and with normal tTG levels.

Results: Adults showed less severe histopathology (26% vs 63%, P < 0.0001) and lower tTG antibody titers than children. Levels of tTG antibody correlated with Marsh type in both populations (r = 0.661, P < 0.0001). Multiple logistic regression revealed that only tTG antibody was an independent predictor for Marsh type 3 lesions, but clinical presentation type and age were not. A cut-off point of 30 U tTG antibody yielded the highest area under the receiver operating characteristic curve (0.854). Based on the predictive value of this cut-off point, up to 95% of children and 53% of adults would be correctly diagnosed without biopsy. Despite GFDs and decreased tTG antibody levels, 25% of the adults did not recover from villous atrophy during the second year after diagnosis.

Conclusion: Strongly positive tTG antibody titers might be sufficient for CD diagnosis in children. However, duodenal biopsy cannot be avoided in adults because disease presentation and monitoring are different.

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Figures

Figure 1
Figure 1
Serum tTG antibody level vs patient age. An inverse relationship was observed for the levels of serum tTG antibody with increasing patient age.
Figure 2
Figure 2
Histopathological differences between children and adults according to Marsh classification.
Figure 3
Figure 3
Serum tTG antibody levels vs Marsh classification. tTG IgA was significantly correlated with Marsh type.
Figure 4
Figure 4
ROC showing the maximum area under the curve for Marsh type 3 histology at cut-off point of 30 U tTG antibody.
Figure 5
Figure 5
Follow-up of adult patients with an initial Marsh type 3 biopsy. Repeated biopsy showed persistent atrophy in 25% of the cases.
See this image and copyright information in PMC

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