PracticeUpdate.com
July 29, 2014
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- This prospective study evaluated the sensitivity and specificity of the serological markers anti-tissue transglutaminase immunoglobulin and anti-deamidated gliadin peptide antibodies for assessing mucosal recovery in children with celiac disease on a gluten-free diet. Duodenal biopsies and serology were taken before and 12 months after starting the diet in 150 children. Serology showed 75% sensitivity and 85% specificity for significant mucosal pathology. None of the 97 children with negative serology had Marsh type 3 enteropathy; 6 of the 27 children with positive serology had Marsh type 3 changes.
- With a negative predictive value of 98%, serological tests may be sufficient in most cases to assess the treatment response of children with celiac disease to a gluten-free diet.
ABSTRACT
OBJECTIVES
Assessment of treatment response in children with celiac disease (CD) after commencing a strict gluten-free diet (GFD) is generally based on the resolution of clinical features and normalization of serology. Recent adult studies have shown that serologic markers do not correlate with mucosal recovery. We aimed (i) to determine whether anti-tissue transglutaminase immunoglobulin (Ig)A (tTG) and anti-deamidated gliadin peptide IgG (DGP) antibodies are sensitive and specific markers of mucosal recovery in children with CD on a GFD for at least 12 months, and (ii) to determine whether a validated dietary questionnaire of compliance can identify patients with mucosal recovery.
METHODS
A total of 150 children with biopsy-proven CD were prospectively evaluated with duodenal biopsies at ≥12 months on GFD, paired with repeat tTG and DGP serology. The biopsies were reviewed in a blinded manner by two histopathologists and graded by Marsh criteria. A validated questionnaire of dietary compliance was also administered.
RESULTS
Of 150 children recruited, 27 (18%) had positive serology, 97 (65%) had negative serology, and 26 (17%) had equivocal serology. Of the 97 children with negative serology, none had Marsh type 3 enteropathy. Of the 27 patients with positive serology, only 6 had Marsh type 3 changes. The sensitivity and specificity of serology as a marker of significant mucosal pathology was 75 and 85%, respectively, with a positive predictive value of 22% but a negative predictive value of 98%. Of the 129 (86%) questionnaires completed, 88% reported good or excellent compliance with a GFD (negative predictive value 97%).
CONCLUSIONS
This study suggests that follow-up using two serological tests in children with CD on a GFD may obviate the need for repeat mucosal biopsy in the majority of patients. A standardized dietary questionnaire may be useful in identifying patients who require further evaluation.
The American Journal of Gastroenterology
Can Celiac Serology Alone Be Used as a Marker of Duodenal Mucosal Recovery in Children With Celiac Disease on a Gluten-Free Diet?
Am. J. Gastroenterol 2014 Jul 29;[EPub Ahead of Print], EG Bannister, DJ Cameron, J Ng, CW Chow, MR Oliver, G Alex, AG Catto-Smith, RG Heine, A Webb, K McGrath, D Simpson, W Hardikar