Open AccessValue of IgA tTG in Predicting Mucosal Recovery in Children With Celiac Disease on a Gluten‐Free Diet
Author(s) -
Leonard Maureen M.,
Weir Dascha C.,
DeGroote Maya,
Mitchell Paul D.,
Singh Prashant,
Silvester Jocelyn A.,
Leichtner Alan M.,
Fasano Alessio
Publication year - 2017
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0000000000001460
Subject(s) - medicine , tissue transglutaminase , gluten free , biopsy , enteropathy , gastroenterology , gluten , immunoglobulin a , serology , disease , coeliac disease , immunology , pathology , antibody , immunoglobulin g , biochemistry , chemistry , enzyme
Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.