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Tissue Transglutaminase Antibody and Its Association with Duodenal Biopsy in Diagnosis of Pediatric Celiac Disease

 ( Meena Daleep K. ) - Great Ormond Street Hospital Pediatric Intensive Care Unit

 ( Akunuri Shalini ) - Great Ormond Street Hospital Pediatric Intensive Care Unit
 ( Meena Preetam ) - Lady Harding Medical College Department of Pediatrics
 ( Bhramer Ashok ) - Government BDM Hospital Department of Pediatrics
 ( Sharma Shiv D. ) - SMS Medical College Department of Pediatrics
 ( Gupta Rajkumar ) - SMS Medical College Department of Pediatrics


Purpose: This study aimed to evaluate a possible association between the anti-tissue transglutaminase antibody (anti-tTG) titer and stage of duodenal mucosal damage and assess a possible cut-off value of anti-tTG at which celiac disease (CD) may be diagnosed in children in conjunction with clinical judgment.

Methods: This observational study was conducted at a gastroenterology clinic in a tertiary hospital from April 2012 to May 2013. Seventy children between 6-months and 18-years-old with suspected CD underwent celiac serology and duodenal biopsy. Statistical analyses were done using SPSS 16. Diagnostic test values were determined for comparing the anti-tTG titer with duodenal biopsy. An analysis of variance and Tukey-Kramer tests were performed for comparing the means between groups. A receiver operating characteristics curve was plotted to determine various cut-off values of anti-tTG.

Results: The mean antibody titer increased with severity of Marsh staging (p<0.001). An immunoglobulin (Ig) A-tTG value at 115 AU/mL had 76% sensitivity and 100% specificity with a 100% positive predictive value (PPV) and 17% negative predictive value (NPV) for diagnosis of CD (p<0.001, 95% confidence interval [CI], 0.75?1).

Conclusion: There is an association between the anti-tTG titer and stage of duodenal mucosal injury in children with CD. An anti-tTG value of 115 AU/mL (6.4 times the upper normal limit) had 76% sensitivity, 100% specificity, with a 100% PPV, and 17% NPV for diagnosing CD (95% CI, 0.75?1). This cut-off may be used in combination with clinical judgment to diagnose CD.


Duodenitis; Celiac disease; Transglutaminase; Antibodies
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