International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: http://www.sciepub.com/journal/ijcd Editor-in-chief: Samasca Gabriel
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International Journal of Celiac Disease. 2013, 1(1), 23-26
DOI: 10.12691/ijcd-1-1-9
Open AccessArticle

The Usefulness of IgA/IgG DGP/tTG Screen Assay for Celiac Disease Detection among Symptomatic and at Risk Young Children

Belei Oana1, and Marginean Otilia1

1First Pediatric Clinic, University of Medicine and Pharmacy Victor Babes Timisoara, Romania

Pub. Date: December 19, 2013

Cite this paper:
Belei Oana and Marginean Otilia. The Usefulness of IgA/IgG DGP/tTG Screen Assay for Celiac Disease Detection among Symptomatic and at Risk Young Children. International Journal of Celiac Disease. 2013; 1(1):23-26. doi: 10.12691/ijcd-1-1-9

Abstract

Background: It has been postulated that IgA anti tissue-transglutaminase (tTG) and anti-endomisium (EMA) antibodies can be false negative in young children.ESPGHAN recommended for seronegative children younger than 2 years old with clinical suspicion of celiac disease to perform duodenal biopsies. Recent studies sugested that the combined assay for IgA/IgG deamidated gliadin peptides (DGP) and tTG can detect celiac disease among seronegative young children. Aim: To assess if the new combined assay with synthetic gliadin derived peptides IgA/IgG-DGP/tTG is useful to detect celiac disease in IgA tTG or EMA seronegative children younger than 2 years old. Methods: The authors screened a lot of children aged 6 months to 2 years old that associated characteristic symptoms/risk factors for gluten enteropathy. 368 children were tested for IgAtTG, EMA and IgA/IgG-tTG/DGP combined assay. All children had normal total IgA concentration and were consuming gluten at the time of enrolment. Children with at least one positive serologic test underwent intestinal biopsy, including seronegative infants, DQ2/DQ8 positive, with clinical suspicion of celiac disease that underwent the 2 biopsies protocol. Results: Celiac disease was diagnosed in 22 children based on histology. 19 children were positive for IgA tTG, 20 were positive for EMA and 21 tested positive for IgA/IgG-DGP/tTG. IgA tTG sensitivity was 86.3%, IgA EMA sensitivity was 91% and IgA/IgG-DGP/tTG sensitivity was 95.4% (p=0.002). Conclusions: The sensitivity of IgA/IgG DGP/tTG assay was significantly higher than that of IgAtTG in celiac patients younger than 2 years old.The better performance of this new combined test can avoid repeated intestinal biopsies in young children with high clinical suspicion of celiac disease but negative tTG/ EMA serology.

Keywords:
celiac disease children serology intestinal biopsies

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References:

[1]  Nandiwada SL, Tebo AE, “Testing for antireticulin antibodies in patients with celiac disease is obsolete: a review of recommendations for serologic screening and the literature”, Clin Vaccine Immunol, 20:447-51, 2013.
 
[2]  Roujon P, Sarrat A, Contin-Bordes C, et al. “Serological diagnosis of celiac disease”, Pathol Biol (Paris)”,61: 39-46,2013.
 
[3]  Naiyer AJ, Hernandez L, Ciaccio EJ, et al. “Comparison of commercially available serologic kits for the detection of celiac disease”, J Clin Gastroenterol, 43:225-32, 2009.
 
[4]  Li M, Yu L, Tiberti C et al. “A report on the International Transglutaminase Autoantibody Workshop for Celiac Disease”, Am J Gastroenterol, 104:154-63, 2009.
 
[5]  Lutteri L, Sagot C, Chapelle JP, et al. “Anti-deamidated gliadin peptides antibodies and coeliac disease: state of art and analysis of false-positive results from five assays”, Ann Biol Clin, 68(2):149-56, 2010.
 
[6]  Byrne G, Freeley M, Feighery C, et al. “Protein kinase C delta is a substrate of tissue transglutaminase and a novel autoantigen in coeliac disease”, Clin Immunol,147(1):1-8, 2013.
 
[7]  Tommasini A, Not T and Ventura A. “Ages of celiac disease: from changing environment to improved diagnostics”, World J Gastroenterol, 28;17(32): 3665-71, 2011.
 
[8]  S. Husby, S. Koletzko, I.R. Korponay-Szabo et al. “European Society for Pediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Diagnosis of Coeliac Disease”, J Pediatr Gastroenterol Nutr,54:136-160, 2012.
 
[9]  Giersiepen K, Lelgemann M, Stuhldreher N et al. “Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report”, J Pediatr Gastroenterol Nutr, 54(2):229-41, 2012.
 
[10]  Sugai E, Hwang HJ, Vázquez H, et al. “New serology assays can detect gluten sensitivity among enteropathy patients seronegative for anti-tissue transglutaminase”, Clin Chem, 56(4):661-5, 2010.
 
[11]  Hojsak I, Mozer-Glassberg Y, Segal Gilboa N, et al. “Celiac disease screening assays for children younger than 3 years of age: the performance of three serological tests”, Dig Dis Sci, 57(1):127-32, 2012.
 
[12]  Aggarwal S, Lebwohl B, Green PH. “Screening for celiac disease in average-risk and high-risk populations”, Therap Adv Gastroenterol, 5(1):37-47, 2012.
 
[13]  Leffler DA, Schuppan D.” Update on serologic testing in celiac disease”, Am J Gastroenterol, 105(12):2520-4, 2010.
 
[14]  Lindfors K, Koskinen O and Kaukinen K. “An update on the diagnostics of celiac disease”, Int Rev Immunol, 30(4):185-96, 2011.
 
[15]  Caja S, Mäki M, Kaukinen K, et al. “Antibodies in celiac disease: implications beyond diagnostics”, Cell Mol Immunol, 8(2):103-9, 2011.
 
[16]  Hogen Esch CE, Rosén A, Auricchio R, et al. “The PreventCD Study design: towards new strategies for the prevention of coeliac disease”, Eur J Gastroenterol Hepatol, 22(12):1424-30, 2010.