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©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Oct 14, 2009; 15(38): 4775-4780
Published online Oct 14, 2009. doi: 10.3748/wjg.15.4775
Duodenal biopsy may be avoided when high transglutaminase antibody titers are present
Santiago Vivas, Jose G Ruiz de Morales, Sabino Riestra, Laura Arias, Dolores Fuentes, Noemi Alvarez, Sara Calleja, Mercedes Hernando, Blanca Herrero, Javier Casqueiro, Luis Rodrigo
Santiago Vivas, Laura Arias, Department of Gastroenterology, Hospital de León, 24080 León, Spain
Jose G Ruiz de Morales, Sara Calleja, Immunology Section, Hospital de León, 24080 León, Spain
Sabino Riestra, Dolores Fuentes, Noemi Alvarez, Luis Rodrigo, Department of Gastroenterology, Hospital Universitario Central de Asturias, 33006 Oviedo, Spain
Mercedes Hernando, Department of Pathology, Hospital de León, 24080 León, Spain
Blanca Herrero, Department of Pediatrics, Hospital de León, 24080 León, Spain
Javier Casqueiro, Faculty of Biology and Environmental Sciences, University of León, 24080 León, Spain
Santiago Vivas, Jose G Ruiz de Morales, Institute of Biomedicine, University of León, 24080 León, Spain
Author contributions: Vivas S, Ruiz de Morales JG and Rodrigo L contributed to the study design and conception; Vivas S, Herrero B, Riestra S, Fuentes D, Arias L, Alvarez N, Casqueiro J and Rodrigo L contributed to the acquisition of data; Hernando M performed the histopathological analysis; Ruiz de Morales JG and Calleja S performed the laboratory analysis; Vivas S, Ruiz de Morales JG, Herrero B, Riestra S, Fuentes D, Arias L, Alvarez N, Calleja S, Herrero B, Casqueiro J and Rodrigo L performed the analysis and interpretation of data; Vivas S, Ruiz de Morales JG and Rodrigo L wrote the manuscript; Vivas S performed the statistical analysis; Riestra S, Fuentes D, Arias L, Alvarez N, Calleja S, Hernando M, and Herrero B carried out a critical revision of the entire manuscript.
Supported by A grant of the Instituto de Salud Carlos III (FIS ref. PI070611) and by a grant of the Junta de Castilla y León, Consejería de Sanidad (Ref 318/A/08)
Correspondence to: Santiago Vivas, MD, Department of Gastroenterology, Hospital de León. Altos de Nava s/n, 24080 León, Spain. svivasa@medynet.com
Telephone: +34-987-234900 Fax: +34-987-233322
Received: July 3, 2009
Revised: August 4, 2009
Accepted: August 11, 2009
Published online: October 14, 2009
AIM: To evaluate the predictive value of tissue transglutaminase (tTG) antibodies for villous atrophy in adult and pediatric populations to determine if duodenal biopsy can be avoided.
METHODS: A total of 324 patients with celiac disease (CD; 97 children and 227 adults) were recruited prospectively at two tertiary centers. Human IgA class anti-tTG antibody measurement and upper gastrointestinal endoscopy were performed at diagnosis. A second biopsy was performed in 40 asymptomatic adults on a gluten-free diet (GFD) and with normal tTG levels.
RESULTS: Adults showed less severe histopathology (26% vs 63%, P < 0.0001) and lower tTG antibody titers than children. Levels of tTG antibody correlated with Marsh type in both populations (r = 0.661, P < 0.0001). Multiple logistic regression revealed that only tTG antibody was an independent predictor for Marsh type 3 lesions, but clinical presentation type and age were not. A cut-off point of 30 U tTG antibody yielded the highest area under the receiver operating characteristic curve (0.854). Based on the predictive value of this cut-off point, up to 95% of children and 53% of adults would be correctly diagnosed without biopsy. Despite GFDs and decreased tTG antibody levels, 25% of the adults did not recover from villous atrophy during the second year after diagnosis.
CONCLUSION: Strongly positive tTG antibody titers might be sufficient for CD diagnosis in children. However, duodenal biopsy cannot be avoided in adults because disease presentation and monitoring are different.
