Abstract

Introduction & Aim: Anti-tissue transglutaminase antibody (tTGA) titer is used during the follow-up of celiac patients to evaluate gluten-free diet (GFD) responsiveness. However, no clear data are available on this issue. The aim of this study was to evaluate tTGA significance during celiac disease (CD) monitoring. Methods: From January 2017 to January 2020, consecutive CD patients on a GFD with persistent positive tTGA were enrolled. Antibody titres were evaluated on a yearly basis from CD diagnosis to the last follow-up. Urinary gluten detection tests, duodenal histology and capsule enteroscopy (CE) were performed. A tTGA-positive cohort was compared with a control group composed of 212 treated CD patients with negative tTGA. Results: 65 patients (12% males, median age at enrollment and CD diagnosis, 37 (14–86) and 31 (1–76), respectively, median follow up 4 (1–26) years) presented with positive tTGA during follow-up. Overall, the tTGA titres were 3 (1–79) fold increased (ULN). Three different tTGA trends were recognized: (I) 36 (55%) patients with a progressive titres decrease; (II) 16 (25%) patients with a fluctuating behavior; (III) 13 (20%) patients with a steady state or increased titres. tTGA+ patients did not present with different clinical and demographic parameters. Duodenal atrophy was present in 10% vs. 36% of the tTGA positive vs. negative group (p < 0.005), respectively. Gluten detection results were positive in 3 (8%) cases, all in the III group. In tTGA+ patients, CE did not identify any CD-related complications. Conclusions: tTGA positivity during CD follow up did not present a relevant clinical significance without association with autoimmune comorbidities and mucosal damage.

Highlights

  • Introduction & AimAnti-tissue transglutaminase antibody titer is used during the follow-up of celiac patients to evaluate gluten-free diet (GFD) responsiveness

  • The diagnosis of celiac disease (CD) is variably defined by four components: symptoms; the presence of HLA-DQ2/DQ8; autoimmune antibodies in serum; and duodenal histology [4,5,6,7]

  • TTGA positivity is followed by a number of invasive investigations, such as endoscopy, to obtain histology samples, and videocapsule endoscopy (VCE), to evaluate the entire small bowel mucosa

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Summary

Introduction

Anti-tissue transglutaminase antibody (tTGA) titer is used during the follow-up of celiac patients to evaluate gluten-free diet (GFD) responsiveness. TTGA are widely used in disease monitoring, but their true significance in clinical practice is not known. In spite of this uncertain significance, routine tTGA testing is recommended in CD monitoring to evaluate GFD adherence and CD remission activity [4,9,10]. How to follow and monitor patients with persistently positive tTGA over time and the clinical significance of this finding represents a challenge in daily practice. The aim of our study was to analyze the clinical significance of tTGA antibodies in a cohort of treated CD patients with persistently positive serology

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