This article is more than 5 years old. Information may no longer be current.
Serological markers benefited children with celiac disease on gluten-free diet
Click Here to Manage Email Alerts
Serological testing of two specific celiac autoantibodies in children with celiac disease adhering to a gluten-free diet effectively identified mucosal recovery, according to new research data.
“Children with celiac disease on a gluten free diet and who have negative serology may not need a repeat endoscopy to determine mucosal healing,” Winita Hardikar, FRACP, PhD, department of gastroenterology, Royal Children's Hospital, Melbourne, told Healio.com/Gastroenterology.
Winita Hardikar
Between August 2009 and October 2011, Hardiker and colleagues prospectively evaluated 150 children (median age at diagnosis, 7.5 years) with celiac disease on a gluten-free diet for a minimum of 12 months. Masked histopathologists graded repeat duodenal biopsy specimens by Marsh criteria. Patients also underwent routine celiac serology at or within 1 month of endoscopy, from which serum tissue transglutaminase (tTG) immunoglobulin A and anti-deamidated gliadin peptide (DGP) IgG antibodies were measured in combination. Dietary adherence was assessed by a standardized questionnaire.
The proportion of patients whose repeat biopsies had returned to normal (Marsh 0) was 82.7%, whereas 5.3% had abnormalities (Marsh 3a and above). Positive serology was measured in 18% of the cohort, whereas 65% tested negative or 17% tested equivocal. None of the patients with negative serology had Marsh type 3 changes. Mucosal healing was detected in 77.7% of patients with positive serology.
Sensitivity of positive serology detecting mucosal pathology was 75% (95% CI, 35-96) and specificity was 85% (95% CI, 78-91). Positive predictive value was 22% (95% CI, 9-42) compared with a negative predictive value of 98% (95% CI, 94-100). Of those who completed the dietary questionnaire, 88% reported good to excellent compliance, and the questionnaire had 33% sensitivity (95% CI, 17-54), 93% specificity (95% CI, 86-97), a positive predictive value of 56% (95% CI, 30-80) and a negative predictive value of 84% (95% CI, 76-90).
“This study confirms that complete mucosal remission is likely in children with diagnosed [celiac disease] who are compliant with a [gluten-free diet],” the researchers concluded. “In addition to their diagnostic value, tTG and DGP antibodies in combination are useful as proxy markers of mucosal healing in children with [celiac disease] on a [gluten-free diet], differentiating them from their adult counterparts, and calling into question the need for routine repeat endoscopic biopsy in the setting of clinical remission and normal serologic values.”
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts