Anti tTG Research Articles

Frequency of microscopic colitis in patients presenting with chronic diarrhea.

Objective: To evaluate frequency of microscopic colitis in patients presenting with chronic diarrhea at a tertiary care hospital in Karachi, Pakistan. Study Design: Descriptive Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: January, 2022 to June, 2022. Material & Methods: Patients presenting in out-patient department of age >18 years of any gender with history of diarrhea >1 month, normal thyroid tests, negative serology for Celiac disease (Anti TTG IgA and IgG), and normal colonoscopy findings including terminal ileum were enrolled in the study after written informed consent. MC diagnosis was established using clinical diarrhea history and colonic biopsy findings. Results: Total 130 patients were analyzed with median age of 38 (IQR= 28-55) years. Nearly half were females (n=67, 51.5%). All patients had normal colonoscopy findings. Out of 130 patients, microscopic colitis was seen among 7(5.4%) cases out of which 5(3.8%) had lymphocytic colitis and 2(1.5%) had collagenous colitis. Patients with and without MC shared the same characteristics. Conclusion: A lower microscopic colitis frequency was found in the studied sample. Lymphocytic microscopic colitis is predominant than collagenous microscopic colitis.

Frequency of celiac disease in patient with irritable bowel syndrome

Background: One of the most prevalent functional gastrointestinal illnesses is irritable bowel syndrome (IBS), which causes a variety of gastrointestinal symptoms, including changed bowel habits and stomach pain or discomfort, without an underlying basis. Objective: To assess the frequency of celiac disease in patient with irritable bowel syndrome. Methodology: This cross sectional study was carried out at the department of gastroenterology, Lady Reading Hospital Peshawar. The duration of study was two years from January 2018 to December 2019. The serological tests for celiac disease like IgA anti TTG and IgG anti TTG was determined. Biopsies were taken on upper gastrointestinal endoscopy. Data was collected in a specialized proforma for our research. All the data collected was analyzed by employing IBM SPSS version 23. Results: In our study, a total of 240 patients with irritable bowel syndrome were enrolled. Gender wise distribution shows that there were 132 (55%) male patients while the female patients were 108 (45%). The mean age of patients (SD) was 26.72 (± 2.27) years. The frequency of celiac disease based on serological testing was 20 (8.33%). The frequency of celiac disease based on histological findings was 15 (6.25%).

Performance Assessment of a Novel Multianalyte Methodology for Celiac Disease Biomarker Detection and Evaluation of the Serology-Alone Criteria for Biopsy-Free Diagnosis.

Serology plays a vital role in celiac disease (CD) diagnosis, and the latest European guidelines advocate for biopsy-free diagnoses in patients with ≥10× the upper limit of normal (ULN) of anti-tissue transglutaminase (tTG) immunoglobulin A (IgA) antibodies. To assess performance characteristics of a novel automated particle-based multianalyte technology (Aptiva) for anti-tTG and anti-deamidated gliadin peptide (DGP) antibody detection as compared to the traditional enzyme-linked immunosorbent assay (QUANTA Lite). Performance characteristics of the ≥10× ULN anti-tTG IgA criteria for serologic diagnosis of CD were also evaluated. Sera samples from 703 patients were tested for anti-tTG IgA, anti-tTG immunoglobulin G (IgG), anti-DGP IgA, and anti-DGP IgG antibodies on both platforms. In total, 127 patients had medical information and were classified as CD-positive (n = 58) and CD-negative (n = 69) based on biopsy results. Clinical performance characteristics were evaluated. Anti-tTG IgA detection showed equal clinical sensitivity and specificity of 91% sensitivity and 99% specificity on both platforms. Anti-tTG IgG resulted in moderate sensitivity of 69% and 72%, but high specificity of 100% and 94% on Aptiva and QUANTA Lite, respectively. Anti-DGP IgG displayed comparable sensitivity of 90% and 81%, and a specificity of 94% and 99%, on Aptiva and QUANTA Lite, respectively. Anti-DGP IgA demonstrated greater sensitivity on QUANTA Lite (83%) than Aptiva (69%) and similar specificities of 97% and 98% on QUANTA Lite and Aptiva, respectively. At ≥10× ULN levels for anti-tTG IgA, Aptiva displayed a sensitivity of 72% and a specificity of 100%, and QUANTA Lite showed a sensitivity of 69% and a specificity of 100%. Aptiva is a reliable method to measure CD biomarkers with reduced hands-on necessity and high-throughput capabilities. This study supports the use of a ≥10× ULN anti-tTG IgA biopsy-free approach for serologic diagnosis of CD.

Prevalence of Celiac Disease Amongst Patients with Chronic Diarrhea: A Cross Sectional Study

Background: An autoimmune disease called celiac disease (CD) causes intolerance of gluten in genetically predisposed individuals. Celiac disease may exhibit a variety of clinical signs, making it difficult to diagnose based purely on symptoms. Objective: To find out the prevalence of celiac disease amongst chronic diarrhea patients Methodology: The current study was cross sectional carried out at the department of Medicine, Khalifa Gul Nawaz Teaching Hospital, Bannu Medical College Bannu from August 2022 to January 2023. All the laboratory examination like blood smear, stool routine examination serum calcium and serum albumin was done. The serological tests for celiac disease like IgA anti TTG and IgG anti TTG was also determined. All the data was documented in a proforma designed for this study. All the data collected was analyzed by employing IBM SPSS version 23. Results: Amongst total 140 patients, the male patients in our study were 67 (47.86%) whereas female patients were 73 (52.14%). The mean age (SD) in the current research was 34 (7.12) years. The overall celiac disease prevalence amongst chronic diarrhea patients was 18 (12.86%). Conclusion: Our study concludes that the prevalence of celiac disease amongst chronic diarrhea patients is very high. Keywords: Prevalence; celiac disease; chronic diarrhea

Helicobacter pylori infection and celiac disease in children, what is the relationship?

Background: Celiac disease (CD) is an autoimmune disease affecting the small intestine, triggered by gluten. The pathogenesis of CD has been well defined, and the increasing prevalence of this disease had led to studying several environmental risk factors that may trigger an autoimmune process in the small intestine. Infection is one of the most important factors that can trigger autoimmune processes. The researchers have studied the association between H. pylori infection and CD, the authors have reported conflicting results. Purpose: to study the association of H. pylori and celiac disease (CD) at the time of CD diagnosis in children. Patient and Methods: All patients in the study were subjected to full history taking, thorough clinical examination, and laboratory investigations including Anti-tissue transglutaminase antibodies (IgA), anti-endomysial (IgA EMA), Stool Ag for H. pylori, CLO test for H. pylori, Immunoglobulins level, Upper gastrointestinal endoscopy with multiple biopsies for histopathological examination. Results: Anti TTG Ig A and Endomysial Ab were positive in 49 patients, while one patient showed negative results. 7 patients (14%) had H.

A Multicenter Cross Sectional Study to Evaluate the Role of Duodenal Bulb Biopsy in the Diagnosis of Celiac Disease

Background and Aim: A systemic immune disorder elicited by dietary gluten in people who are genetically predisposed to it is referred to as a celiac disease. D1 had been ruled out as a biopsy site due to concerns about Brunner's glands, peptic duodenitis, gastric metaplasia, and presumed reduced villous height. Due to histological confounding factors, the duodenal bulb (D1) as a biopsy site was traditionally avoided. The present study aimed to assess the duodenal bulb biopsy role in the diagnosis of celiac disease. Methodology: This multicenter cross sectional study was conducted on 108 celiac disease patients in the department of Gastroenterology, Bacha Khan Medical Complex, Swabi, North West General hospital Peshawar and Pir Abdul Qadir Shah Jilani Institute of Medical Science Gambat Khairpur, Sindh from September 2020 to July 2021. All the celiac disease patients were clinically symptomatic and had anti-tissue transglutaminase (anti TTG IgA) positive antibodies. Endoscopically, six mucosal biopsies were taken from each patient, four each from the distal duodenum and two additional biopsy separately labelled was taken from bulb. Modified Marsh grading was used for morphological grading. Results: Of the total 108 Celiac disease patients, 60 (55.6%) were females and 48 (44.4%) were male patients. the overall mean age was 32.62±6.4 years. Prior to diagnosis of Celiac disease, symptoms median duration was 5.4 years with a range of 6 months to 40 years. The most prevalent clinical presentation were iron deficiency anemia 43% (n=46) and chronic diarrhea 32% (n=35) respectively. Other clinical presentation were chronic pain abdomen, infertility, short stature, and cirrhosis. Elevated TTG of 117.1 ± 49.82 U/ml was measured in all the patients with a range of 20 to 250 U/ml. The incidence of similar and different modified Marsh grade was in 66 (61.1%) and 42 (58.9%) respectively at both site. Out of 42 different modified March grade patients, higher mucosal atrophy in bulb and descending duodenum showed higher grade in 16 and 26 patients respectively. Isolated bulb involvement was seen in nine patients. Due to bulb biopsy, Celiac disease diagnosis was correctly done in these patients. Conclusion: The present study supported the villous atrophy and intraepithelial lymphocytosis patchy nature in biopsy specimens of celiac disease. The diagnosis of celiac disease improved with inclusion of duodenal bulb biopsies in our sampling protocol. Celiac disease patchy nature and distribution demonstrated different Marsh grades in different biopsy sites. The celiac disease diagnostic yield is increased by combining the bulb and the descending duodenum biopsy. Keywords: Celiac Disease, Duodenal bulb biopsy, Modified Marsh grade

Prevalence and epidemiological profile of celiac disease in children with type 1 diabetes mellitus: Experience from a tertiary care center of India.

The HLA associations of celiac disease (CD) in north Indians differ from that in Europeans. Our dietary gluten is among the highest in the world. Data on CD in people with diabetes (PWD) in north India is scant. To estimate the prevalence and clinical profile of CD in children with type 1 diabetes (T1D). Retrospective review of case records of PWD with onset ≤18 years of age, registered between 2009 and 2020, having at least one anti tissue-transglutaminase (anti-tTG) serology report. Of 583 registered PWD, 398 (68.2%) had celiac serology screening. A positive report was obtained in 66 (16.6%). Of 51 biopsied people, 22 (5.5%) were diagnosed to have CD, 12 in the first 2 years of diabetes onset. Symptomatic CD at diagnosis was seen in 63% (14/22). Age at diabetes onset (median [IQR] age 5.5 years, [2-12]) was lower in PWD and CD compared to PWD alone (10 years, [7-14], p < 0.016). Of 36 biopsied children with anti-tTG >100 au/ml, 20 (55.5%) had CD, while 2 out of 15 (13.3%) of those with lower anti-tTG titer had histopathology suggestive of CD. Of 23 seropositive children not diagnosed with CD, 5 of 8 with anti tTG >100 au/ml, and all 15 with lower anti-tTG, had normalization of titers over the 24 (10-41) months. Our prevalence of CD is comparable to international data. Celiac disease was common with younger age at onset of T1D and higher titer of celiac serology. A high proportion was symptomatic of CD at diagnosis.

Serological study of celiac disease in children with dental caries.

Celiac disease is a common gastrointestinal autoimmune disorder. Studies have shown that the prevalence of tooth decay is high in patients with celiac disease. This study was performed to evaluate the serology of celiac disease in children with dental caries. Children aged 3 to 12years who referred to the dental clinic with enamel caries were included in the study. Celiac disease was assessed by measuring serum IgA levels and anti-TTG (Anti TTG (IgA)) antibodies. Then, by analyzing the collected data, the prevalence of celiac disease in children with dental caries and its relationship with various variables were investigated. 120 children, 56 girls (46.7%) and 64 boys (53.3%) with dental caries were involved in this study. The positive celiac serology rate of studied population was 14 (11.6%). Based on the results of this study, a significant relationship was obtained between maternal education, sex and place of residence and celiac disease (p< 0.05). There were no significant relationships between celiac positive serology in children with dental caries, the number of decayed teeth, and breastfeeding (p> 0.05). The present study showed that dental caries, might be a red flag indicating possible celiac disease and prevent its complications. On the other hand, pediatricians and dentists should be aware of the oral symptoms of celiac disease. Further studies are needed to plan screening for children with celiac disease.

SPECTRUM OF HISTOPATHOLOGICAL PATTERNS OF DUODENAL BIOPSIES IN PATIENTS WITH UNEXPLAINED ANAEMIA AND CHRONIC DIARRHEA AND THEIR CORRELATION WITH ENDOSCOPIC FINDINGS AND SEROLOGICAL MARKERS

Objective: To evaluate different histopathological patterns and correlate them with indications, findings of Esophagogastroduodenoscopy Esophago-gastro-duodenal (EGD) and serological markers in patients presenting of unexplained anemia and chronic diarrhea.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: Departments of Pathology and Gastroenterology, Combined Military Hospital Lahore Pakistan, from Jul to Dec 2020.&#x0D; Methodology: Histopathological patterns of endoscopic duodenal biopsies, submitted for evaluation of unexplained anemia and chronic diarrhea were studied. Hemoglobin and anti-tTG levels were recorded. Adults with history of unexplained diarrhea and anaemia were included. Biopsies with malignant diagnosis or unfit for evaluation were excluded. Histopathological patterns were correlated with indications and findings of Esophagogastroduodenoscopy and serological markers of celiac disease.&#x0D; Results: The most common indication for Esophagogastroduodenoscopy in 145 patients was chronic diarrhea. Upper gastrointestinal endoscopy in 2/3rd of patients revealed no pathology. Histopathological patterns of duodenal biopsies revealed only 15% cases suggestive of celiac disease. Only 12 patients were suggestive of celiac disease both on Esophagogastroduodenoscopy and histopathology combined. Half of patients with anti tTG level &gt;100 u/ml, showed histopathological features of celiac disease on. There was no correlation between histopathological patterns, indications of Esophagogastroduodenoscopy, morphology of Esophagogastroduodenoscopy and serological markers of celiac disease.&#x0D; Conclusion: Indications for Esophagogastroduodenoscopy, Esophagogastroduodenoscopic findings and histopathological patterns cannot diagnose celiac disease alone.

Screening for Celiac Disease in Newly Diagnosed Children with Type I Diabetes

Abstract Background Type I diabetes (T1D) is an autoimmune disease caused by the immune-mediated destruction of insulin-producing pancreatic β cells.. Celiac disease is 5-7 percent more common in people with T1D than in the general population. Objectives The aim of this study was to detect the incidence of coeliac disease among newly diagnosed T1D children by assessment of Anti-tissue Transglutaminase Antibody (anti-tTG), IgA. Methods Fifty children with newly diagnosed T1D and another 15 age and sex –matched healthy individuals were subjected to screening for celiac disease by measuring total body IgA and antiTtg(IgA). Results the incidence of positive anti tTG(IgA) Ab among our T1D patients was found to be 12%. Upon comparing children with positive anti tTG(IgA) Ab with those with negative anti tTG(IgA) Ab we found that children with +ve anti tTG(IgA) Ab were significantly shorter than those with -ve anti tTG(IgA) Ab(p &amp;lt; 0.05). Also HbA1c among our diabetic children with +ve anti tTG(IgA) Ab was significantly higher than those with -ve anti tTG(IgA) (p &amp;lt; 0.05). Gastrointestinal manifestations were significantly higher among T1D patients with anti tTG (IgA)+ve than those with anti tTG(IgA)- ve.(p &amp;lt; 0.001). Conclusion Anti tTG(IgA) Ab levels are elevated in children and adolescents with type 1 diabetes compared with healthy controls with incidence rate of about 12%. Anti tTG(IgA) Ab test can be used as screening test for celiac disease among type1 DM.

Serum Anti TTG Level as a Predictor for Severity of Intestinal Damage in Children with Celiac Disease

AbstractIntroduction: This study aimed at evaluating how the patient’s clinical manifestations and his/her anti TTG level are correlated with the intensity of histological damage based on the classification of Marsh Oberhuber.Methods: This cross-sectional study was performed on 186 children suspected to celiac disease who referred to gastroenterology clinic between 2014 and 2015 and had Anti TTG >20. All patients underwent upper gastrointestinal endoscopy and multiple biopsies of duodenum were taken; histological classification was performed based on Marsh Oberhuber criteria. Finally, the relationship between serum levels of Anti TTG and histologic findings was assessed based on Marsh Oberhuber criteria.Results: There was a statistically significant difference between Anti TTG and different classes of grading March (P=0.01). Moreover, the intensity of intestinal damage based on Marsh Oberhuber criteria was significantly higher in children who referred with gastrointestinal complaints, the classic form of celiac disease and growth disorder. Anti TTG level of 148 IU/ml was the best positive cutoff point suggested by the ROC. For anti TTG level of 148 IU/ml, sensitivity, specificity, positive predictive value and negative predictive value were 46.8%, 82.4%, 91.7%, and 27.2%, respectively.Conclusion: Anti TTG level of 148 IU/ml has a high positive predictive value and a low negative predictive value for histologic changes more than grade 1 in Marsh classification.

Prevalence of celiac disease in irritable bowel syndrome patients: A single centre experience from a large teaching hospital of Lahore, Pakistan

Background: Many studies have been conducted worldwide to evaluate the proportion of patients with Celiac disease (CD) in persons presenting with Irritable Bowel Syndrome (IBS), showing a positive association between the two diseases. However, reports from Pakistan remain scanty. This study aims to find out the prevalence of CD in patients presenting with IBS and to establish the correlation of both diseases.&#x0D; Patients and methods: It was a descriptive cross-sectional study conducted at Combined Military Hospital, Lahore (CMHL) from January 2018 till March 2019. Consecutive, nonprobability sampling was used to include 210 patients of both genders with the age range of 15-65 years fulfilling ROME IV criteria and were not previously diagnosed as CD or CKD or CLD. Demographic data was noted. Serum Anti tTG levels and Duodenal Biopsy from the second part was assessed to diagnose CD. CD was labeled if the disease was present on both serological and Histopathological reports. Data were analyzed by using SPSS version 20. Descriptive statistics were calculated and a Chi-square test was used to compare the outcome variables with P-value &lt; 0.05 as significant.&#x0D; Results: Of 210 enrolled patients, 113 (53, 8%) were male and 97 (46.2%) were female. The mean age of the patients was 28.40 ± 5.06 years. Eight patients (3.8%) were positive for Anti tTg and on histopathological findings suggestive of CD. Seven of 8 were less than 35 years old. Out of 8 positive patients, 6 (75%) were females. However, the p-value was found to be insignificant for age (0.549) and gender (0.096). On stratification with respect to duration of IBS, all 8 patients diagnosed with celiac disease were having symptoms of IBS for less than 12 months (100%) which was significant statistically (7.1% vs 0.0%; p=0.007).&#x0D; Conclusion: The frequency of CD was 3.8% among IBS patients. Considering this percentage of CD in IBS patients s, a high index of suspicion for CD in IBS patients is required,

The impact of celiac disease and duration of gluten free diet on anterior and posterior ocular structures: Ocular imaging based study.

To evaluate the eyes of adult celiac disease (CD) patients and investigate the association between these ocular parameters with celiac specific antibodies and duration of gluten free diet (GFD). This cross-sectional study included 72 eyes of 36 CD patients (18-51 years of age) and 70 eyes of 35 age- and sex-matched healthy controls. In addition to a complete ophthalmologic examination, all patients were scanned by a Scheimpflug camera, specular microscopy and spectral domain optical coherence tomography. Endothelial cell density (ECD), anterior chamber angle (ACA) degrees, anterior chamber depth (ACD), anterior chamber volume (ACV) and central macular thickness (CMT) values were lower in CD patients as compared with control group (p values = 0.038, 0.024, 0.002, 0.038 and 0.046 respectively). ECD and CMT were lower in celiac patients whom endomysial antibodies (EMA) IgA were positive (p = 0.001, p = 0.042 respectively). Tissue transglutaminase IgA antibody (anti tTG IgA) was weakly positively correlated (p > 0.05) with ACD, and positively (r = 0.319; p < 0.05) correlated with ACV. As the duration of compliance to the diet increased in the celiac group the mean and inferior retinal nerve fiber layer (RNFL) thickness decreased (p = 0.035, p = 0.008 respectively). Mean, inferior and temporal RNFL thicknesses were lower in celiac patients whose duration of GFD was longer than 5 years (p < 0.05). Decreases in ECD, ACA degree, ACD, ACV and CMT can occur in CD patients. In adult celiac patients; ECD, CMT might be effected in the presence of positive EMA, and ACD, ACV might be effected in the presence of higher anti tTG IgA titer. Adult celiac patients who had longer duration of GFD may have thinner RNFL. RNFL may be thinner in celiac patients who comply with GFD for more than 5 years.

Diagnostic utility of multiple site duodenal biopsies in celiac disease.

Celiac Disease involves the small intestine patchily affecting more frequently the proximal small bowel but the histological changes have been observed till terminal ileum. Of late in addition to D2, the duodenal bulb (D1 region) biopsies have been found helpful in identifying a small group of patients with CD. Therefore, multiple site biopsies are recommended as histological changes are not uniform throughout small intestine. During this present 1.5 years prospective study, we evaluated 84 cases of suspected celiac disease with respect to the light microscopy (D1, D2, and D3 biopsy) and serology (anti tTg and or EMA). Histological examination was done according to Modified Marsh grading system. Out of 84 cases with raised anti tTg, the segmental biopsies significantly increased the diagnostic accuracy from 39/44 cases (88.6%) to 43/44 cases (97.7%) and 44/44 cases (100%) when D2 alone, D1 + D2 and D1 + D2 + D3 biopsies were evaluated, respectively. Of the suspected cases of celiac disease patients (tTg > 10 ULN and associated weight loss, diarrhea), additional D3 biopsy increased the diagnostic yield by 2.1%, compared to D1, D2 region biopsy and 6.38% compared to standard D2 biopsy alone. Of the 28 cases (tTg > 10 times ULN + EMA positive and associated weight loss, diarrhea), the potential celiac disease (histologically Type 1/Normal) cases reduced from 28.5% (standard D2 region alone) to 21.4% and 17.8% when additional biopsies were taken from D1 region and D3 region, respectively, and additional D3 biopsy increased the diagnostic yield by 10.8% (compared to standard D2 biopsy alone) and 3.7% (compared to D1 and D2 biopsy). We believe multiple sites duodenal biopsies including D3 region biopsies might increase the diagnostic accuracy of adult celiac disease in addition to sensitive and specific serologic tests.

“Strongyloides stercoralis infestation in a severely malnourished (SAM) celiac disease child:” A rare case report from Western Rajasthan

A case of Strongyloides stercoralis infection in severe protein energy malnutrition child with associated celiac disease (CD) is herein reported. The case was a 4-year-old, severely malnourished female admitted to the tertiary level hospital of Western Rajasthan, due to watery diarrhea, pain abdomen, and vomiting, not responding to treatment. The patient was HIV negative, nondiabetic, had no evidence of tuberculosis, Liver Function Test, Renal Function Test were normal was within normal limits. She had microcytic hypochromic anemia, hypoalbuminemia, and serum Antitissue transglutaminase (anti tTG IgA)was 301.35 U/ML which confirmed the diagnosis of CD. Stool parasitological examination revealed numerous rhabditiform larvae of threadworm “S. stercoralis.” After treatment with gluten free diet and Albendazole and Ivermectin, the patient recovered without evidence of S. stercoralis in follow-up stool samples.

Correlation between Clinical Symptoms of Coeliac Disease, Serum IgA Anti TTG and Biopsy in Pediatric Population of Northern India

Background: Celiac disease is basically an immune-mediated enteropathic condition produced by permanent sensitivity to gluten in genetically susceptible subjects. There is paucity of data in north India regarding clinical symptoms of coeliac disease, Serum IgA Anti TTG and Biopsy in pediatric population. The present study was conducted with the aim to determine the correlation between clinical symptoms of coeliac disease, Serum IgA Anti TTG and Biopsy in pediatric population of northern India.Materials and Methods: The present study was conducted in prospective including 73 pediatric patients at Department of Pediatric Gastroenterology, Institute of Child Health, Sir Gangaram Hospital, New Delhi, India. Esophagogastroduodenoendoscopy and serum anti Ig A tissue transglutaminase were performed. The characteristic scalloping of the folds were looked for in endoscopy followed by four duodenal biopsies performed from second part of duodenum and histological grading was performed as per modified marsh system. Patients with Serum IgA anti tTG&gt;20 U/ml were confirmed to be at risk. Complete histological work up was done including hemoglobin, RBC indices and peripheral blood smear examination. The association of clinical manifestations with disease grade was also established with correlation coefficient. All the data thus obtained was arranged in a tabulated form and analyzed using SPSS software. Probability value of less than 0.05 was regarded as significant.Results: There were 4 males and 16 females with marsh grade 1 and 2 and mean age of 7.3±1.9 years. There were 5 males and 8 females with marsh grade 3a and mean age of 6.8±2.3 years. The mean weight of 18.11±3.89, height of 103.17±8.73 and BMI of 16.26±3.78 was observed amongst subjects with Marsh grade 1 and 2. The mean weight of 15.12±3.17, height of 99.28±9.19 and BMI of 15.02±3.20was observed amongst subjects with Marsh grade 3a. Diarrhoea was maximum amongst subjects with grade 3c and 4(70%) and minimum amongst Grade 1 and 2 (40%). There was a significant difference between the frequency of anemia amongst different grades as the p value was less than 0.05.Conclusion: The most common presenting signs and symptoms were diarrhea and abdominal pain. The study also concluded that the incidence of anemia increases with higher marsh grades.

Chemiluminescent Immunoassay versus Enzyme Linked Immunosorbent Assays for IgA Anti-Tissue Transglutaminase Antibodies Assessment in Celiac Disease Children

Recent describing of atypical, silent and latent form of celiac disease (CD) increased the preocupation for screening methods.To perform a comparative study of immunoglobulin A (IgA) anti tissue-transglutaminase (tTG) antibodies (Ab) assessment using chemiluminescence versus Enzyme Linked Immunosorbent Assay (ELISA).The study included two lots.The first lot consisted in 35 biopsy confirmed CD children aged between two and 18 years.The control lot included 40 children with normal duodenal morphology on intestinal biopsy that underwent upper digestive endoscopy for different gastrointestinal symptoms.Serum samples were provided from all subjects for IgA measurement, IgA anti tTG and EMA assessment. Immulite 2500 Anti tTG IgA (Siemens Co, LA, USA) and ImmuLisa anti-hu tTG antibody IgA ELISA (Immco Diagnostics Inc, NY, USA) kits were used for tTG-Ab assessment. All children underwent HLA typing for DQ2/DQ8. The sensitivity for IgA tTG assessment was greater for chemiluminescence (93,3%) versus ELISA (86,6%), p[0,05, while specificity, positive and negative predictive value didn�t register significant differences. Statistical comparison of the two tested methods revealed a better sensitivity for chemiluminescence. Diagnosis algorithm optimisation may be obtained by associating IgA anti tTG-Ab assessment using chemiluminescence followed by EMA confirmation by indirect immunofluorescence for CD screening.

Prevalence of anti-tissue transglutaminase antibodies in patients with irritable bowel syndrome in Duhok city

BackgroundIrritable bowel syndrome (IBS) is a common gastrointestinal disorder; celiac disease is an autoimmune enteropathy that can mimic any functional gastrointestinal disorder. The aim of this study is to estimate the prevalence of celiac disease antibodies (anti Tissue Transglutaminase—tTG) in patients with irritable bowel syndrome. Patients and methodsThis cross sectional study was conducted on 70 patients with irritable bowel syndrome fulfilling Rome III criteria who visited Azadi Teaching Hospital in Duhok city—Iraq. Patients were classified according to irritable bowel syndrome subtypes into: Diarrhoea Predominant (D-IBS), Constipation Predominant (C-IBS) and Mixed (M-IBS). IgA and IgG anti tTG were used to screen patients for celiac disease. ResultsA total number of 70 patients (44 females and 26 males) were included; their mean age was 33 years (SD±7.64). Five patients (7.1%) were found to have positive both IgA and IgG anti tTG. Three of them have had D-IBS and the other two had C-IBS. No one of the M-IBS patients tested positive. ConclusionThe prevalence of anti tTG antibodies in irritable bowel syndrome is high. Patients with D-IBS should be screened for celiac disease.

Anti tissue transglutaminase antibody in idiopathic autoimmune haemolytic anemia

BackgroundIn idiopathic autoimmune haemolytic anaemia (AIHA haemolytic antibodies are directed to every type of red cellsWestern blot studies have shown antibody positivity towards red cell anion channel complex which also includes band 4.2 a protein with similarities to tissue trans glutaminase. ObjectiveEvaluation of AIHA for anti tissue transglutaminase antibody (Anti tTG). Materials & methodsTwenty three AIHA patients were tested along with routine hamatogical work up, for a series of auto antibodies and red cell eluates and serum from the patents were tested against solubilised group O red cell ghosts on western blot. Other ancillary investigations were done to rule out complications and secondary causes of haemolysis. Results11/23 patients (48%) were positive for anti tTG, Four, 3 and 8,7 patients were positive for anti thyroid, anti b2 glycoprotein, lupus anticoagulant and ANA respectively. One patient with anti tTG had biopsy proven celiac disease. Three patient developed DVT and all of them were lupus anticoagulant as well as b2 gp-1 antibody positive.17 had become Coombs test negative on treatment while 21/23 had positive western blot test. Discussion & conclusionThere is strong association of anti tTG antibody with idiopathic AIHA. Aetiological association of this finding needs exploration.

Celiac Disease as Chylous Ascites in a Child

10 year old with no significant history either in the past or family presented with tense ascites, hypochromic microcytic anemia, thrombocytosis and milky fluid with TAG level of 350 mg/dl with a SAAG of >1.1. LFT, chest xray and ascitic fluid ADA were normal. USG abdomen showed fine echoes from peritoneal cavity and normal liver and portal /hepatic veins. endoscopy was done to look for lymphangiectasia but gross morphology of duodenum was suggestive of celiac disease. Normal IgA, high anti TTG, biopsy marsh IIIB and clinical response to gluten free diet confirmed the diagnosis of celiac disease.