Relationship Between Villous Atrophy and tTGA Levels in Dyspeptic Patients: A Case Series.

Muhammad S Achakzai,Helmand Khan Tareen,Khushhal Khan,Zara Arshad,Aurangzeb Baloch,Hamaiyal Sana,Saliha Kakar,Muhammad Samsoor Zarak,Aqeel Nasim

doi:10.7759/cureus.15043

Muhammad S Achakzai, Helmand Khan Tareen + Show 7 more

Open Access

https://doi.org/10.7759/cureus.15043

Copy DOI

Abstract

AimThe objective of the study was to observe the association of villous atrophy with anti-tissue transglutaminase levels in the identified subjects that met our addressed inclusion criteria.MethodsA case series study was conducted among 40 patients presenting with dyspepsia along with signs and symptoms of celiac disease at the Bolan Medical Complex Hospital, Quetta over a period of five months from 25/5/17 to 25/10/17. The patients were referred to undergo tissue transglutaminase antibody serum test. The positive ones underwent biopsies to assess pathological entities including villous atrophy, blunting (focal or total), crypts, Intestinal layers and the number of Intraepithelial lymphocytes. The results collected were analyzed by using IBM SPSS version 20 (IBM Corp., Armonk, NY).ResultsThere was a weak, negative correlation between tTGA and focal villous blunting (r = -0.345, p = 0.029) showing that high levels of tTGA are associated with lower risk of focal villous blunting. Correlation of tTGA and total villous blunting was a weak positive correlation (r = 0.282, p = 0.07) showing that high levels of tTGA are associated with increased risk of total villous blunting. There was a weak, negative correlation between tTGG and focal villous blunting (r = 0.409, p = 0.009) showing thathigh levels of tTGG are associated with a greater risk of focal villous blunting (p < 0.01) while tTGG and total villous blunting was a weak negative correlation (r = -0.330, p = 0.03) showing that high levels of tTGG are associated with lower risk of total villous blunting.ConclusionThe study concludes by providing evidence of the absence of tissue transglutaminase antibodies in patients with histology-proven celiac disease. It implies that serology tests may be negative in some of the patients with typical chronic symptoms. Therefore, in such cases, histopathology may be conclusive in defining the status of celiac disease.

Highlights

There was a weak, negative correlation between tTGG and focal villous blunting (r = 0.409, p = 0.009) showing that high levels of tTGG are associated with a greater risk of focal villous blunting (p < 0.01) while tTGG and total villous blunting was a weak negative correlation (r = -0.330, p = 0.03) showing that high levels of tTGG are associated with lower risk of total villous blunting
Villous atrophy is the condition of inflammation of intestinal mucosa [1], which results in loss of structural entity that in turn compromises the absorptive functions of the intestines
Celiac disease is an autoimmune disease of the small intestine that is triggered by consumption of glutton present in wheat or some other related proteins found in rye, and barley [3]

Summary

Introduction

Villous atrophy is the condition of inflammation of intestinal mucosa [1], which results in loss of structural entity that in turn compromises the absorptive functions of the intestines. Celiac disease is an autoimmune disease of the small intestine that is triggered by consumption of glutton present in wheat or some other related proteins found in rye, and barley [3]. On ingestion, this gluten shows some classic symptoms like chronic diarrhea, steatorrhea, and weight loss. The diagnosis for celiac disease is done on the basis of the presence of the human leukocyte antigen genetic factor, accompanied by positive biopsy and serological antibodies Among these serological markers, IgA anti-tissue transglutaminase shows a sensitivity of more than 95% (CI, 77%-100%) and specificity greater than 95% (CI, 1%-100%) [4].

Objectives

Methods

Results

Discussion

Conclusion