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Objective: We aimed to evaluate the relationship between Tissue Transglutaminase IgA titer (tTGIgA) and Endomisium antibody (EMA) positivity and the stage of duodenal mucosal damage at Celiac disease (CD).
Material and Methods: The study group consisted of 233 children (2-18 years old) who were diagnosed with CD and admitted to our XXX Hospital, Pediatric Gastroenterology Outpatient Clinic, between September 2017 and November 2022. All patients underwent an endoscopy, and a histopathological diagnosis was made. In upper gastrointestinal endoscopy, one biopsy sample were taken from the duodenum bulb and four samples from the second part of the duodenum. Histological patterns were evaluated according to the Marsh-Oberhuber classification.
Results: A total 233 patients with CD were included in the study. The mean age of the patients at the time of diagnosis was 97.0 ± 57.1 months. The patients' mean tissue transglutaminase (tTG) IgA value was 172 ± 133. The most common Marsh-Oberhuber classification was found to be Marsh 3b (47.6%) in CD patients. According to the Marsh-Oberhuber classification, the mean tTGIgA values were significantly different compared to the groups.
Conclusion: We recommend starting a diet with a diagnosis of CD without endoscopy for patients with a tTGIgA value of 10 X ULN (upper limit of normal) or more recommended by ESPGAN, and we even support randomized prospective studies to reduce this value to 7-10 times or less.
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Paul SP, Harries SL, Basude D. Barriers to implementing the revised ESPGHAN guidelines for coeliac disease in children: a cross-sectional survey of coeliac screen reporting in laboratories in England. Arch Dis Child. 2017;102(10):942-46.
Meena DK, Akunuri S, Meena P, Bhramer A, Sharma SD, Gupta R. Tissue Transglutaminase Antibody and Its Association with Duodenal Biopsy in Diagnosis of Pediatric Celiac Disease. Pediatr Gastroenterol Hepatol Nutr. 2019;22(4):350-57.
Kalhan S, Joseph P, Sharma S, Dubey S, Dudani S, Dixit M. Comparative study of histopathological Marsh grading with clinical and serological parameters in celiac iceberg of north India. Indian J Pathol Microbiol 2011;54:279-83.
Husby S, Murray JA, Katzka DA. AGA Clinical Practice Update on Diagnosis and Monitoring of Celiac Disease-Changing Utility of Serology and Histologic Measures: Expert Review. Gastroenterology. 2019;156(4):885-89.
Gülseren YD, Adiloğlu AK, Yücel M, Dağ Z, Eyerci N, Berkem R, et al. Comparison of non-invasive tests with invasive tests in the diagnosis of celiac disease. J Clin Lab Anal. 2019;33(3):e22722.
Singh P, Arora A, Strand TA, Leffler DA, Catassi C, Greenet PH. et al. Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2018;16:823–36
Fabiani E, Catassi C; International Working Group. The serum IgA class anti-tissue transglutaminase antibodies in the diagnosis and follow up of coeliac disease. Results of an international multi-centre study. International Working Group on Eu-tTG. Eur J Gastroenterol Hepatol. 2001;13(6):659-65.
Husby S, Koletzko S, Korponay-Szabó I, Kurppa K, Mearin ML, Ribes-Koninckx C, et al. European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. J Pediatr Gastroenterol Nutr. 2020;70(1):141-56.
Vermeersch P, Geboes K, Mariën G, Hoffman I, Hiele M, Bossuyt X. Defining thresholds of antibody levels improves diagnosis of celiac disease. Clin Gastroenterol Hepatol. 2013;11(4):398-403; quiz e32.
Vivas S, Morales J, Fernandez M, Hernando M, Herrero B, Casqueiroet J, et al. Age‐related clinical, se‐ rological, and histopathological features of Celiac disease. Am J Gastroenterol. 2008;103:2360‐65.
Alessio MG, Tonutti E, Brusca I, Radice A, Licini L, Sonzogni A, et al. Study Group on Autoimmune Diseases of Italian Society of Laboratory Medicine. Correlation between IgA tissue transglutaminase antibody ratio and histological finding in celiac disease. J Pediatr Gastroenterol Nutr. 2012;55(1):44-9.
Kaswala DH, Veeraraghavan G, Kelly CP, Leffler DA. Celiac Disease: Diagnostic Standards and Dilemmas. Diseases. 2015;3(2):86-101.
Tola D, Marino M, Goetze S, Casale R, Di Nardi S, Borghini R, et al. Identification of a serum transglutaminase threshold value for the noninvasive diagnosis of symptomatic adult celiac disease patients: a retrospective study. J Gastroenterol. 2016;51(11):1031-39.
Beig J, Rostami K, Hayman DTS, Hassan S, Gerred S, Ogra R. Is duodenal biopsy always necessary for the diagnosis of coeliac disease in adult patients with high anti-tissue transglutaminase (TTG) antibody titres? Frontline Gastroenterol. 2021;13(4):287-294.
Penny HA, Raju SA, Lau MS, Marks LJ, Baggus EM, et al. Accuracy of a no-biopsy approach for the diagnosis of coeliac disease across different adult cohorts. Gut. 2021;70(5):876-83.
Mubarak A, Wolters VM, Gerritsen SA, Gmelig-Meyling FH, Ten Kate FJ, Houwen RH. A biopsy is not always necessary to diagnose celiac disease. J Pediatr Gastroenterol Nutr. 2011;52(5):554-7.
Vermeersch P, Geboes K, Mariën G, Hoffman I, Hiele M, Bossuyt X. Serological diagnosis of celiac disease: comparative analysis of different strategies. Clin Chim Acta. 2012;413(21-22):1761-7.
Zanini B, Magni A, Caselani F, Lanzarotto F, Carabellese N, Villanacci V, et al. High tissue-transglutaminase antibody level predicts small intestinal villous atrophy in adult patients at high risk of celiac disease. Dig Liver Dis. 2012;44(4):280-5.
Oberhuber G, Granditsch G, Vogelsang H. The histopathology of celiac disease: time for a standardized report scheme for patholo‐ gists. Eur J Gastroenterol Hepatol. 1999;11:1185‐94.