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Meta-Analysis
. 2021 Dec 21;14(1):7.
doi: 10.3390/nu14010007.

Diagnostic Accuracy of IgA Anti-Transglutaminase and IgG Anti-Deamidated Gliadin for Diagnosis of Celiac Disease in Children under Two Years of Age: A Systematic Review and Meta-Analysis

Giulia N Catassi  1 , Alfredo Pulvirenti  2 , Chiara Monachesi  3 , Carlo Catassi  4   5 , Elena Lionetti  4
Affiliations
Meta-Analysis

Diagnostic Accuracy of IgA Anti-Transglutaminase and IgG Anti-Deamidated Gliadin for Diagnosis of Celiac Disease in Children under Two Years of Age: A Systematic Review and Meta-Analysis

Giulia N Catassi et al. Nutrients. .

Abstract

The need of adding the determination of anti-deamidated gliadin peptide (DGP) IgG to anti-transglutaminase (TTG) IgA antibodies for diagnosis of celiac disease (CD) in children <2 years of age is controversial. We performed a systematic review and meta-analysis to evaluate, by head-to-head comparison, the diagnostic accuracy of TTG IgA and DGP IgG antibodies. We searched PubMed, MEDLINE, and Embase databases up to January 2021. The diagnostic reference was intestinal biopsy. We calculated the sensitivity and specificity of these tests and the odds ratio (OR) between the tests. Fifteen articles were eligible for the systematic review and ten were eligible for the meta-analysis. Sensitivity and specificity were 0.96 (95% confidence interval (CI), 0.91-0.98) and 0.96 (95% CI, 0.85-0.99) for DGP IgG and 0.93 (95% CI, 0.88-0.97) and 0.98 (95% CI, 0.96-0.99) for TTG IgA, respectively. TTG IgA specificity was significantly higher (OR 9.3 (95% CI, 2.3-37.49); p < 0.001) while the sensitivity of DGP IgG was higher without reaching statistical significance (OR: 0.6 (95% CI, 0.24-1.51); p = 0.28). Both the meta-analysis and the systematic review showed that some children with early CD are missed without the DGP IgG test. In children <2 years of age, TTG IgA is the best CD screening test; however, the addition of DGP IgG may increase the diagnostic sensitivity.

Keywords: anti-deamidated gliadin peptide antibodies; anti-transglutaminase antibodies; celiac disease; children.

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Conflict of interest statement

Carlo Catassi served as a consultant for Schär SPA, and Takeda. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of study selection.
Figure 2
Figure 2
Forest plot for sensitivity and specificity of immunoglobulin G anti-deamidated gliadin peptide antibody (DGP IgG) determination.
Figure 3
Figure 3
Forest plot for sensitivity and specificity of immunoglobulin A anti-tissue transglutaminase antibody (TTG IgA) determination.
Figure 4
Figure 4
Forest plot of direct comparison of sensitivity between immunoglobulin G anti-deamidated gliadin peptide antibody (DGP IgG) and immunoglobulin A anti-tissue transglutaminase antibody (TTG IgA) determination. Only comparative primary studies reporting the number of total true positives (TP) and false negatives (FN) for DGP IgG and TTG IgA are included.
Figure 5
Figure 5
Forest plot of direct comparison of specificity between immunoglobulin G anti-deamidated gliadin peptide antibody (DGP IgG) and immunoglobulin A anti-tissue transglutaminase antibody (TTG IgA) determination. Only comparative primary studies reporting the number of total true negatives (TN) and false positives (FP) for DGP IgG and TTG IgA are included.
See this image and copyright information in PMC

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