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. 2022 Apr 20;19(9):5020.
doi: 10.3390/ijerph19095020.

Evaluation of Celiac Disease by Minimally Invasive Biomarkers in a Spanish Pediatric Population

Julia María Cabo Del Riego  1   2 , María Jesús Núñez Iglesias  3   4 , Carmen García-Plata González  5 , José Paz Carreira  5 , Tamara Álvarez Fernández  1 , Ana Dorado Díaz  6 , Noa Villar Mallo  1 , Manuel Penedo Pita  1 , Silvia Novío Mallón  3   4 , Lola Máiz Suárez  1 , Manuel Freire-Garabal Núñez  4   7
Affiliations

Evaluation of Celiac Disease by Minimally Invasive Biomarkers in a Spanish Pediatric Population

Julia María Cabo Del Riego et al. Int J Environ Res Public Health. .

Abstract

Background: The diagnosis of celiac disease (CD) has been substantially improved with the availability of highly sensitive CD-specific IgA-TG2, Ig-GDP, and IgA-EMA. The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) published (2012) and updated (2020) diagnostic criteria for CD in order to simplify CD diagnosis and to avoid biopsies in selected patients.

Methods: A prospective study including 5641 pediatric patients (0-16 years old) from January 2012 to January 2019 was performed. CD diagnosis was made according to the ESPGHAN algorithm. The objective of this study was to evaluate the utility of biomarkers and the relationship between TGA-IgA and EMA titers.

Results: CD diagnoses were confirmed in 113 patients, 110 were IgA-TG2-positive and 3 (2.7%) had IgA deficiency. The diagnosis was made by serologic tests in 95 (84.1%) patients. Only 18 (15.9%) patients underwent intestinal biopsy. We obtained 100% concordance between IgA-EMA and positive results for IgA-TG2 ≥ 10 ULN with IgA-EMA antibody titer ≥ 1:80.

Conclusions: This study provides evidence of a positive correlation between IgA-TG2 antibody serum levels and IgA-EMA. The diagnosis could be guaranteed with strict application of IgA-TG2 values ≥ 10 ULN (confirmed by subsequent testing) plus the serological response to the gluten-free diet (GFD).

Keywords: ESPGHAN; antibodies; celiac disease; diagnosis; non-invasive biomarkers; pediatric age.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
CD diagnosis process with main results. Abbreviations: CD, celiac disease; ESPGHAN, European Society for Pediatric Gastroenterology, Hepatology, and Nutrition; GFD, gluten-free diet; GI, gastroenterologist; HLA, human leukocyte antigen; IgA, immunoglobulin A; IgA-EMA, IgA anti-endomysial antibodies; IgA-TG2, IgA antibodies against tissue transglutaminase Type 2; IgG, immunoglobulin G; IgG-GDP, IgG antibodies against deamidated gliadin peptides; PAD, primary attention doctor; ULN, upper limit of normal.
Figure 2
Figure 2
Relationship between IgA-TG2 and EMA titers. A non-parametric test comparing the medians among four groups of EMA. p < 0.001. Abbreviations: IgA-EMA, IgA anti-endomysial antibodies; IgA-TG2, IgA antibodies against tissue transglutaminase Type 2. ° Outliers are values between the IORs and three IORs from the end of a box. * Values more than three IORs from the end of a box.
Figure 3
Figure 3
Relationship between age and IgA-TG2. Abbreviations: IgA-TG2, IgA antibodies against tissue transglutaminase Type 2. °, Outliers are values between IORs and three IORs from the end of a box. * Values more than three IORs from the end of a box.
Figure 4
Figure 4
Values of IgA-TG2 (U/mL) in patients who avoided biopsy or underwent it. Abbreviations: IgA-TG2, antibodies against tissue transglutaminase Type 2. °, Outliers are values between IORs and three IORs from the end of a box. * Values more than three IORs from the end of a box.
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