Open AccessDiagnostic Value of Persistently Low Positive TGA‐IgA Titers in Symptomatic Children With Suspected Celiac Disease
Author(s) -
Trovato Chiara Marja,
Montuori Monica,
Morelli Annalisa,
Alunni Fegatelli Danilo,
Vestri Annarita,
Giordano Carla,
Cucchiara Salvatore,
Caio Giacomo,
Oliva Salvatore
Publication year - 2021
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.0000000000003047
Subject(s) - medicine , esophagogastroduodenoscopy , gastroenterology , receiver operating characteristic , titer , area under the curve , immunoglobulin a , tissue transglutaminase , antibody , immunology , immunoglobulin g , endoscopy , biochemistry , chemistry , enzyme
Objectives: While the algorithm to diagnose celiac disease (CD) in children with elevated anti‐transglutaminase IgA (TGA‐IgA) titers (>10 times upper limit of normal, ULN) is well defined, the management of children with low TGA‐IgA values represents a clinical challenge. We aimed to identify the diagnostic value of persistently low positive TGA‐IgA titers in predicting CD in children. Methods: We retrospectively analyzed children with symptoms or signs of CD, not eligible for a no‐biopsy approach. We included children with at least 2 TGA‐IgA measurements, endomysial antibody (EMA) assessment and esophagogastroduodenoscopy with biopsies. TGA‐IgA values were provided as multiples of ULN. Patients were classified in groups according to median TGA‐IgA values: A (TGA‐IgA>1 ⩽ 5 × ULN; defined as “low‐positive”), B (TGA‐IgA > 5 < 10 × ULN; “moderate‐positive”), and C (controls). Results: Data of 281 children were analyzed. Of 162 children in group A, CD was diagnosed in 142 (87.7%), whereas normal duodenal mucosa was found in 20. In group B, all 62 children (100%) received a CD diagnosis. Group C included 57 controls. EMA were undetectable in 31 (15%) of mucosal atrophy cases. On the receiver‐operating characteristic curve (area under the curve = 0.910), a mean value of 1.7 ULN showed a sensitivity of 81.4% and specificity of 81.8% to predict mucosal damage. Conclusions: Repeated low or moderate TGA‐IgA values (<5 ULN or <10 ULN) are good predictors of a CD diagnosis. Symptomatic children with persistently low positive TGA‐IgA titers should undergo esophagogastroduodenoscopy regardless of their EMA status.