జీర్ణకోశ & జీర్ణ వ్యవస్థ

నైరూప్య

Is a Small Intestinal Biopsy Always Necessary to Diagnose Celiac Disease in Children?

Serge A. Sorser, Tammy Tran, Karen Hagglund3, Alexander Lyons, Hernando Lyons, Kamran Kalim

Objectives: The purpose of this study was to assess the diagnostic accuracy of the tissue transglutaminase antibody (tTG-Ab) for celiac disease (CD) in children.

Methods: A retrospective chart review of children suspected to have CD from January 2007 to December 2011 was conducted. Patients were excluded if they had an Immunoglobulin A (IgA) deficiency, an autoimmune disorder or were following a gluten-free diet at the time of presentation. Gender, age at the time of small bowel biopsy, chief complaint, family history of celiac disease, serum IgA and tTG-Ab were recorded. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of tTG-Ab compared to biopsy result were calculated, using three different cut-off values of tTG-Ab: >100 U/mL, >200 U/mL, and >300 U/mL.

Results: 174 patients were included. 51% were male and the mean ± SD age was 9.8 ± 5.0 years. Chief complaints included abdominal pain (63.8%), diarrhea (14.9%), failure to thrive (14.4%), and vomiting (12.1%). 11.5% (20) of the patients had a family history of CD. 22 (13%) had a positive biopsy and 51(29%) had an abnormal tTG Ab level, with 13 patients >100 U/mL, 12 patients >200 U/mL, and 10 patients >300 U/mL. The specificity and PPV for the three groups were 97% and 77%, 99% and 92%, 100% and 100% respectively.

Conclusion: Low sensitivity precludes the use of tTG-Ab as a screening test, although tTG-Ab >300 U/mL has a very high specificity and PPV for celiac disease. In pediatric patients with clinical features suggestive of celiac disease, a tTG-Ab of >300 U/mL may be used to diagnose CD, avoiding duodenal biopsy.