Abstract
BackgroundThe objective of our study was to assess whether TG2A levels in the healthy childhood population can be predictive of subclinical CD.MethodsA total of 4442 children (median age, 6.0 years) participating in a population-based prospective cohort study were screened on serum TG2A. Those with positive TG2A (≥7 U/ml; n = 60, 1.4%) were invited for clinical evaluation (median age, 9.0 years). Medical history, physical examination, serum TG2A, and IgA-endomysium (EMA) were assessed, as well as HLA DQ 2.2/2.5/8 typing. Patients with positive serologies and genetic risk types underwent duodenal biopsies. TG2A levels at the time of biopsy were compared with the degree of enteropathy.ResultsFifty-one TG2A-positive children were included in the follow-up: 31 (60.8%) children had CD, ten (19.6%) did not have CD, and ten (19.6%) were considered potential CD cases because of inconclusive serologies. Duodenal biopsies were performed in 26/31 children. CD with Marsh 3a/b enteropathy was observed in 75% (15/20) of children having TG2A levels ≥10ULN at 6 years of age, as well as in 75% (6/8) of children having a positive TG2A <10 ULN (OR 1.00; 95% CI 0.15–6.64). CD cases had a lower BMI SDS (mean −0.49, SD 0.92) than children without CD (mean 0.47, SD 1.37; p = 0.02). No differences were observed in gastrointestinal symptoms.ConclusionsSerum TG2A screening at 6 years of age in the healthy childhood population has a positive predictive value of 61% to detect subclinical CD. We did not find a positive correlation between serum TG2A levels and the degree of enteropathy.
Highlights
Celiac disease (CD) is one of the most common, but largely underdiagnosed chronic diseases in childhood, and associated with excess morbidity and mortality [1]
Of 60 children, eight were lost to follow-up, and one child was diagnosed with CD at 5 years of age and excluded from analyses
The second serology was not conclusive in seven children: they carried the genetic risk type, but had TG2A concentrations \3 upper limit normal (ULN), or TG2A levels were negative in accordance with a positive EMA, whereas the initial screening TG2A test result at 6 years of age was positive
Summary
Celiac disease (CD) is one of the most common, but largely underdiagnosed chronic diseases in childhood, and associated with excess morbidity and mortality [1]. Several studies have shown that high TG2A levels (C10 times upper limit normal of the test; ULN) have a high specificity for severe enteropathy (Marsh 3) in symptomatic patients [16,17,18]. It is still recommended to evaluate biopsies in asymptomatic or screening-identified individuals, irrespective of TG2A levels [19], some studies argue the need in subclinical and screening-detected patients with TG2A levels C10 ULN values [20]. Methods A total of 4442 children (median age, 6.0 years) participating in a population-based prospective cohort study were screened on serum TG2A. Those with positive TG2A (C7 U/ml; n = 60, 1.4%) were invited for clinical evaluation (median age, 9.0 years). Electronic supplementary material The online version of this article (doi:10.1007/s00535-017-1354-x) contains supplementary material, which is available to authorized users.
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