Identification of a serum transglutaminase threshold value for the noninvasive diagnosis of symptomatic adult celiac disease patients: a retrospective study.

Abstract

BACKGROUND:

A celiac disease (CD) diagnosis is based on duodenal histology, with the exception of children showing anti-tissue transglutaminase (anti-tTG) serum levels exceeding ten times the cut-off. Our aim was to reproduce this simplified approach in adults, identifying an anti-tTG threshold value useful to diagnose CD without endoscopic procedures.

METHODS:

A total of 671 adult CD patients were subjected to blood sampling to determine anti-tTG serum levels, as well as to endoscopy with biopsy to perform duodenal histology. The anti-tTG serum levels/cut-off ratio was compared with the degree of duodenal lesions.

RESULTS:

Anti-tTG serum levels/cut-off ratio determined in patients with type IIIc was significantly higher than that measured in patients with type IIIb (p < 0.001), IIIa (p < 0.001), II (p < 0.05) and 0 (p < 0.001) of Marsh-Oberhuber histological classification. A significant correlation (r = 0.297, p < 0.0001) was found between the anti-tTG serum levels/cut-off ratio and the degree of duodenal lesions. The anti-tTG serum levels/cut-off ratio was classified as an accurate parameter (AUC = 0.715, p < 0.0001), with the best diagnostic performance obtained considering the threshold value >3.6 (sensitivity = 76.8 %, PPV = 97.2 %).

CONCLUSIONS:

The anti-tTG serum levels/cut-off ratio correlates with the degree of duodenal lesions and, if used with the threshold value >3.6, could avoid endoscopy with biopsy in about 75 % of seropositive adults waiting for CD diagnosis. However, since this procedure could also imply CD diagnosis in almost 3 % of seropositive patients with normal villous architecture, a consensus opinion is needed to suggest its use in the diagnosis of adult CD.

• Authors: Marco Di Tola, Mariacatia Marino, Simone Goetze, Rossella Casale, Sara Di Nardi, Raffaele Borghini, Giuseppe Donato, Antonio Tiberti, Antonio Picarelli
• Journal: Journal of gastroenterology (J Gastroenterol) Vol. 51 Issue 11 Pg. 1031-1039 (Nov 2016) ISSN: 1435-5922 [Electronic] Japan
• PMID: 26928588 (Publication Type: Journal Article)

Chemical References

• Autoantibodies
• Biomarkers
• Immunoglobulin A
• Transglutaminases

Topics

• Adolescent
• Adult
• Aged
• Autoantibodies (blood)
• Biomarkers (blood)
• Biopsy
• Celiac Disease (diagnosis, pathology)
• Duodenoscopy
• Duodenum (pathology)
• Female
• Histocompatibility Testing (methods)
• Humans
• Immunoglobulin A (blood)
• Male
• Middle Aged
• Predictive Value of Tests
• ROC Curve
• Retrospective Studies
• Sensitivity and Specificity
• Transglutaminases (immunology)
• Young Adult