Screening Test For Coeliac Disease Research Articles

Prevalence and detection rate of celiac disease in Italy: Results of a SIGENP multicenter screening in school-age children.

Celiac disease is a common lifelong disorder. Recent studies indicate that the number of clinically detected cases has increased over the last decades, however little is known about changes in the prevalence and the detection rate of celiac disease. To evaluate the current prevalence and detection rate of celiac disease in Italy by a multicenter, mass screening study on a large sample of school-age children. children aged 5-11 years were screened at school by HLA-DQ2 and -DQ8 determination on a drop of blood in six Italian cities; total serum IgA and IgA anti-transglutaminase were determined in children showing HLA-DQ2 and/or -DQ8 positivity. Diagnosis of celiac disease was confirmed according to the European guidelines. 5994 children were eligible, 4438 participated and 1873 showed predisposing haplotypes (42.2%, 95% CI=40.7-43.7). The overall prevalence of celiac disease was 1.65% (95% CI, 1.34%-2.01%). Only 40% of celiac children had been diagnosed prior to the school screening. Symptoms evoking celiac disease were as common in celiac children as in controls. In this multicenter study the prevalence of celiac disease in school-age Italian children was one of the highest in the world. Determination of HLA predisposing genotypes is an easy and fast first-level screening test for celiac disease. Without a mass screening strategy, 60% of celiac patients remain currently undiagnosed in Italy.

Serum positivity of serum anti-tissue transglutaminase immunoglobulin A antibodies in Japanese children with inflammatory bowel disease.

Serum anti-tissue transglutaminase immunoglobulin A antibody (tTG-IgA) is a screening test for celiac disease (CeD). In recent years, there have several reports of combined inflammatory bowel disease (IBD) and CeD in children. The purposes of this study are to research the positivity of the tTG-IgA antibody in Japanese children, and whether IBD and CeD co-occur. We examined tTG-IgA as a screening test for CeD in symptomatic pediatric patients with IBD (cases) and those without IBD (controls, non-IBD). Those with tTG-IgA levels of 10U/mL or higher were considered positive. All patients had routine biopsy specimens taken from the second part and bulbus of the duodenum, and were evaluated histologically based on the Marsh classification. Thirty-one patients in the IBD group and 53 patients in the non-IBD group were included. The tTG-IgA was positive in five cases (5.9%) and median titer of positive cases was 12.3U/mL (10.2-41.7). One patient in the IBD group (3.2%) and four patients in the non-IBD group (7.8%) were positive for tTG-IgA. No cases showed histological features of CeD. There were no statistically significant differences in age, sex, symptoms and laboratory tests between the tTG-IgA positive and negative groups. Patients among the IBD and the non-IBD groups that were tTG-IgA positive demonstrated symptoms after wheat consumption. We identified a patient who was positive for tTG-IgA antibodies who experienced abdominal symptoms due to wheat ingestion, indicative of subclinical CeD. Further investigation is needed to clarify the co-occurrence of IBD and CeD among Japanese children.

Diagnostic Accuracy of Serum Anti-Tissue Transglutaminase Antibody in Diagnosis of Pediatric Celiac Disease

Background: Celiac disease (CD) is an immune mediated enteropathy that is caused by intolerance to gluten storage protein of wheat bartey and rice. Early diagnosis of celiac disease is highly imperative to institute early intervention in order to prevent profound macronutrient deficiencies as well as long term complications. Diagnostic investigation for celiac disease, the matter of controversy, with endoscopic duodenal biopsy remaining the gold standard but invasive, costly, painful, needing expertise and carrying risks of endoscopy, while serologic tests although noninvasive, cheap, easily available but with disputed specificity and sensitivity. Objective: To find the accuracy and importance of anti-tissue transglutaminase IgA antibody in celiac disease diagnosis and determination in pediatric patients. Place and Duration of Study: Department of Pediatrics, GMMMC Hospital Sukkur from 1st June 2019 to 30th November 2019. Methodology: One hundred and fifty children were suspected celiac diseases were enrolled. Demographic data including age, gender was noted. Duodenal biopsy and upper GI endoscopy of all patients with positive anti-tTG was performed. At least 6 biopsy specimens were taken from first and second part of duodenum and duodenal bulb. Results: Mean age of the children was 8.72±1.92 years. Sensitivity, specificity, PPV and NPV of tTG-IgA in evaluating celiac disease was 86.9%, 84.8%, 88%, 83.6% and 86% respectively. Conclusion: Tissue transglutamianse (TTG) is an excellent screening test for celiac disease in high risk Paediatric population having diagnostic accuracy of 86%. Therefore, it can be safely recommended that patients having even fewer clinical features should be screened by TTG to detect celiac disease patients with minimal signs and symptoms. Keywords: Celiac disease, IgA anti-tissue transglutaminase, Gastrointestinal endoscopy

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 < 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 < 0.05). Gastrointestinal manifestations were significantly higher among T1D patients with anti tTG (IgA)+ve than those with anti tTG(IgA)- ve.(p < 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.

Accuracy of Screening Tests for Celiac Disease in Asymptomatic Patients With Type 1 Diabetes

To evaluate the diagnostic performance of celiac serologic tests in asymptomatic patients with type 1 diabetes (T1D). Patients with T1D asymptomatic for celiac disease were prospectively screened with immunoglobulin A anti-tissue transglutaminase. Test characteristics were calculated and optimal cutoffs for a positive screen determined. Two thousand three hundred fifty-three patients were screened and 101 proceeded to biopsy. The positive predictive value of immunoglobulin A anti-tissue transglutaminase at the assay referenced upper limit of normal (30CU) was 85.9%, and the sensitivity and specificity were 100% and 38%, respectively. Thresholds extrapolated from the general population for the diagnostic evaluation of celiac disease are not suitable for use in asymptomatic T1D patients. Population-specific screening cutoffs are required.

Prevalence of Celiac Disease in Children with Type 1 Diabetes Mellitus in the South of Turkey

Background: Type 1 Diabetes Mellitus (DM), autoimmune disorders, relatives of celiac patients have higher risk of developing celiac disease (CD) because they share the same HLA type. Celiac disease and type 1 DM are autoimmune and common in children. According to international guidelines, serological screening for CD in children and adults with type 1 DM is recommended but there is no consensus on how often it will be performed. Objectives: We aimed to investigate the prevalence of CD in children with type 1 diabetes mellitus (DM). Methods: This current study was carried out between 01 March 2017 and 15 December 2018. 273 children with type 1 DM were included in the study. Tissue transglutaminase antibody IgA (tTG IgA) and total IgA levels were measured in all patients. The patients with tTG IgA positivity underwent gastroduodenoscopy. Results: Of the 273 patients (139 girls), the mean age was 11.61 ± 3.73 years. tTG IgA was positive in 23 patients, and 2 of them refused the process of endoscopy. Gastroduodenoscopy was performed on other patients. 11 patients with Marsh 3, 2 patients with Marsh 2, 4 patients with Marsh 1, and 4 patients with Marsh 0 were detected in the present study. In other words, 12 patients were diagnosed with CD. Nine of 12 patients diagnosed with CD were diagnosed within the first 5 years after the diagnosis of type 1 DM. Conclusions: We found that the prevalence of biopsy-proven CD in children with type 1 DM was 4.4%, which was approximately 9 times higher than the prevalence of CD in the general population. In the current study, 9 of 12 patients diagnosed with CD were diagnosed within the first 5 years after DM. According to our results, we recommend that screening tests for CD should be performed at least once a year for 5 years in children with Type 1 DM, even if the patients are asymptomatic.

Misuse of serological screening tests for celiac disease in children: A prospective study in Italy

BackgroundDespite a well-established diagnostic algorithm for celiac disease, it remains unclear whether prescriptions for celiac serological tests comply with the current pediatric guidelines. AimTo analyze the appropriateness of test prescription in children investigated for celiac disease in Italy, compared to the current European pediatric guidelines. MethodsAll children who had performed a first evaluation for celiac disease were prospectively enrolled. Prescribed tests and related indications for testing were recorded, and compared to the European pediatric guidelines. ResultsOverall, 202 children were enrolled (females 59%, mean age 7.1 years ±4.1) in two centers. The reasons for celiac disease testing were typical, atypical symptoms or celiac disease-associated conditions in 46.5%, 49%, and 4.5% of cases, respectively. First-line tests were IgA and IgG anti-transglutaminase antibodies in 88.1% and 29.7% of children, IgA and IgG anti-deamidated gliadin peptide antibodies in 43% and 47%, IgA and IgG anti native gliadin in 15.8%, IgA anti-endomysium antibodies in 44.5%, HLA predisposing genes in 10% of patients. Test redundancy was very common, and the current diagnostic guidelines were correctly followed only in 23/202 patients (11.4%). ConclusionsDiagnostic European guidelines for celiac disease screening are often disregarded in Italy. Intervention to implement adherence to these guidelines is needed, with the aim of improving resource utilization, and quality of patient care.

Role of HLA-DQ typing and anti-tissue transglutaminase antibody titers in diagnosing celiac disease without duodenal biopsy in type 1 diabetes: A study of the population-based pediatric type 1 diabetes cohort of Western Australia.

The primary aim of the present study was to determine if it is cost effective to use human leukocyte antigen (HLA) typing as a first-line screening test for celiac disease (CD) in children with type 1 diabetes (T1D), as recommended by the European Society of Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN). The second aim was to investigate whether anti-tissue transglutaminase IgA (anti-tTGA) antibodies can be used to diagnose CD without the need for a confirmatory duodenal biopsy in T1D. Data for all T1D patients aged <18 years, who attended the diabetes clinics in Western Australia up to June 2017, were extracted from the Western Australian Children's Diabetes Database (WACDD) and analyzed for their demographic data and CD permissive HLA alleles (DQ2, DQ8, and DQ7). For T1D patients already diagnosed with CD, the mode of diagnosis of CD, anti-tTGA titers, and CD permissive HLA alleles were analyzed. Of the 936 eligible T1D patients identified, HLA-DQ typing was available for 551 (59%). Of these 551 patients, 504 (91.2%) were positive for celiac permissive HLA alleles. Eight percent (n = 75) of the T1D patients had a co-diagnosis of CD. High anti-tTGA titers were observed in those who were diagnosed with a positive duodenal biopsy. HLA-DQ typing is not cost effective as a first-line screening test for CD in T1D patients because of over-representation of CD permissive HLA alleles in this group. Anti-tTGA titers may be useful in diagnosing CD in T1D without duodenal biopsy, as high levels were found to be strongly predictive of CD.

Diagnostic Accuracy of Serologic Screening Tests for Celiac Disease in Asymptomatic Adults and Children with Type 1 Diabetes

Background: As related autoimmune conditions, celiac disease (CD) is more common in individuals with type 1 diabetes (T1D) and is frequently asymptomatic. Despite this association, evidence as to the diagnostic accuracy of screening as well as the potential benefits or harms of screening for CD is limited in asymptomatic patients with T1D. Methods: T1D patients, aged 8-45 years, were serologically screened for CD at multiple centers across Ontario, Canada as part of the Celiac Disease and Diabetes Dietary Intervention and Evaluation Trial (CD-DIET). Patients were deemed asymptomatic on the basis of the absence of GI symptoms, weight changes, anemia and other CD-related clinical features. Screening was conducted in 2,386 patients using chemiluminescent (CL, BioFlash™) and/or ELISA (Celikey™) tissue transglutaminase (TTG) IgA assays, yielding 140 positives. Of these, 104 patients had a duodenal biopsy with CD confirmation (Marsh ≥2). Receiver operating characteristic (ROC) curve analysis was conducted and positive predictive values (PPV) of available screening tests for CD were evaluated. Results: CL and ELISA data were available for 100/104 and 36/104 patients, respectively. The area under the curve of the ROC for CL TTG was 0.918, while the PPV using the manufacturer referenced upper limit (RUL) of 30 CU was 85.9% (95% CI: 82.3-90.8%). According to our data, an optimal cut-off of 156.5 CU, or 5.2 times the RUL, showed an improved PPV of 95.8% (95% CI: 92.4-100.0%). With respect to ELISA TTG, the PPV was 94.4% at the RUL of 8 U/ml and reached to 100% at the optimal cut-off determined by our analysis of 58.7 U/ml, which translates to 7.3 times the RUL. Conclusion: Results from serologic CL and ELISA TTG assays that were greater than 5 times the reported upper limit showed a high PPV for biopsy-confirmed CD in asymptomatic adult and pediatric T1D patients, which may help guide diagnostic evaluation in this population. Disclosure M. Gould: None. F.H. Mahmud: None. A.B. Clarke: None. E. Assor: None. A. Parikh: None. A. Advani: Research Support; Self; AstraZeneca, Boehringer Ingelheim GmbH. Other Relationship; Self; Boehringer Ingelheim GmbH. B.A. Perkins: Advisory Panel; Self; Boehringer Ingelheim GmbH. Research Support; Self; Boehringer Ingelheim GmbH, Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc., Abbott. Speaker's Bureau; Self; Abbott, Janssen Pharmaceuticals, Inc.. Advisory Panel; Self; Insulet Corporation. Speaker's Bureau; Self; Insulet Corporation, Dexcom, Inc.. B.R. Shah: None. C.S. Zuijdwijk: None. C. McDonald: None. D. Mack: None. D. Koltin: None. E. Hsieh: None. E.M. Szentgyorgyi: None. F. Saibil: None. G. Mukerji: None. H.A. Lochnan: Research Support; Self; Amylin Pharmaceuticals, Boston Therapeutics, Inc., Sanofi. J. Gilbert: Other Relationship; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk Inc., Janssen Pharmaceuticals, Inc., Sanofi. K. Bax: None. M.L. Lawson: None. M.D. Beaton: Advisory Panel; Self; Takeda Canada Inc., Janssen Pharmaceuticals, Inc., AbbVie Inc.. N.A. Saloojee: None. O. Lou: None. P.H. Gallego: None. R.L. Houlden: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc., AstraZeneca, Eli Lilly and Company. R. Aronson: Other Relationship; Self; Novo Nordisk Inc., Janssen Pharmaceuticals, Inc., Sanofi, AstraZeneca. Research Support; Self; Eli Lilly and Company, Becton, Dickinson and Company, Merck &amp; Co., Inc., Senseonics, Boehringer Ingelheim Pharmaceuticals, Inc.. S.E. Kirsch: None. W.G. Paterson: None. Z. Punthakee: Research Support; Self; Amgen, Astra Zeneca/Bristol Myers Squibb, Lexicon, Merck, NovoNordisk, Sanofi. Speaker's Bureau; Self; Abbott, Astra Zeneca/Bristol Myers Squibb, Boehringer Ingelheim/Eli Lilly, Janssen, Merck, NovoNordisk, Pfizer, Sanofi. Advisory Panel; Self; Astra Zeneca/Bristol Myers Squibb, Boehringer Ingelheim/Eli Lilly, Dexcom, Janssen, Medtronic, NovoNordisk, Pfizer, Sanofi. M.A. Marcon: None.

Celiac disease in non-clinical populations of Japan.

Celiac disease is a chronic autoimmune enteropathy caused by gluten ingestion. While its prevalence in Western countries is reported to be as high as 1%, the prevalence has not been evaluated in a large-scale study of a Japanese population. The aim of our study was to clarify the possible presence of celiac disease in a Japanese non-clinical population as well as in patients showing symptoms suggestive of the disease. Serum samples were collected from 2008 non-clinical adults and 47 patients with chronic unexplained abdominal symptoms between April 2014 and June 2016. The anti-tissue transglutaminase (TTG) immunoglobulin A antibody titer was determined as a screening test for celiac disease in all subjects, and individuals with a value of >2U/mL subsequently underwent testing for the presence of serum endomysial IgA antibody (EMA) as confirmation. Those testing positive for EMA or with a high concentration (>10U/mL) of TTG were further investigated by histopathological examinations of duodenal mucosal biopsy specimens and HLA typing tests. Of the 2008 non-clinical adults from whom serum samples were collected, 161 tested positive for TTG, and all tested negative for EMA. Four subjects who had a high TTG titer were invited to undergo confirmatory testing, and the histopathological results confirmed the presence of celiac disease in only a single case (0.05%). Of the 47 symptomatic patients, one (2.1%) was found to have a high TTG titer and was diagnosed with celiac disease based on duodenal histopathological findings. The presence of celiac disease in a non-clinical Japanese population was low at 0.05% and was rarely found in patients with unexplained chronic abdominal symptoms.

The Prevalence of Celiac Disease in Children With Arterial Ischemic Stroke.

The association between arterial ischemic stroke (AIS) and celiac disease (CD) has been described in only a few cases in adults and children. We aim to determine the prevalence of CD in children and adolescents with AIS. We investigated serum levels of tissue transglutaminase antibody immunoglobulin (Ig)A and total IgA from 76 children with AIS and in a healthy control group of 102 children. Study participants who were positive for tissue transglutaminase IgA antibodies underwent a duodenal biopsy. A total of 2 patients in the AIS group (2.26%) and 2 in the control group (1.96%) had positive serum tissue transglutaminase antibody (P=0.89; 95% confidence interval, -5.05 to 6.89). Duodenal biopsy confirmed CD in only 1 patient who had AIS. In the present study, children with acute arterial stroke did not exhibit a higher prevalence rate of CD compared with healthy controls. Therefore, the screening test for CD is not a necessary part of the management of AIS in children. However, cases of recurrent AIS could be examined for CD.

Is Celiac Disease an Etiological Factor in Children With Migraine?

To determine the prevalence of celiac disease in children and adolescents with migraine, the authors investigated serum levels of tissue transglutaminase antibody immunoglobulin A and total immunoglobulin A from 81 children with migraine and in a healthy control group of 176 children. Study participants who were positive for tissue transglutaminase immunoglobulin A antibodies underwent a duodenal biopsy. Two patients in the migraine group (2.5%) and 1 in the control group (0.57%) tested positive for serum tissue transglutaminase immunoglobulin A antibodies (P > .05). Duodenal biopsy did not confirm celiac disease in both groups, and these patients were considered "potential celiac" cases. In the present study, children with migraine did not exhibit a higher prevalence rate of celiac disease compared with healthy controls. Therefore, the screening test for celiac disease is not a necessary part of the management of migraine in children.

Is Celiac Disease an Etiological Factor in Children with Nonsyndromic Intellectual Disability?

To determine the prevalence of celiac disease in children and adolescents with nonsyndromic intellectual disability, we investigated serum levels of tissue transglutaminase antibody and total IgA from 232 children with nonsyndromic intellectual disability and in a healthy control group of 239 children. Study participants who were positive for tissue transglutaminase antibody underwent a duodenal biopsy. A total of 3 patients in the nonsyndromic intellectual disability group (5.45%) and 1 in the control group (0.41%) had positive serum tissue transglutaminase antibody (P > .05). Duodenal biopsy confirmed celiac disease in only 1 patient who had nonsyndromic intellectual disability. In this present study, children with nonsyndromic intellectual disability did not exhibit a higher celiac disease prevalence rate compared with healthy controls. Therefore, we suggest that screening test for celiac disease should not be necessary as a part of the management of mild and moderate nonsyndromic intellectual disability. However, cases of severe nonsyndromic intellectual disability could be examined for celiac disease.

PTH-252 Investigation of iron deficiency anaemia. duodenal biopsies – are they worth it?

<h3>Introduction</h3> The prevalence of iron deficiency anaemia (IDA) in adult men and postmenopausal women in the developed world is 2–5%.¹British Society of Gastroenterology (BSG) IDA Guidelines recommend tissue transglutaminase (tTG) antibody as a screening test for coeliac disease. Indications for duodenal biopsies include patients with diarrhoea, weight loss and positive tTG serology. Where coeliac serology is positive, duodenal bulb and D2 biopsies should be taken.²BSG IDA Guidelines do not recommend duodenal biopsy for tTG negative, asymptomatic patients.³However a separate BSG guideline for diagnosis of coeliac disease recommends duodenal biopsies in IDA patients irrespective of Coeliac serology due to the finding of seronegative coeliac disease.² <h3>Method</h3> This audit was carried out to assess adherence to BSG IDA Guidelines for duodenal biopsies in patients referred for IDA investigation with negative tTG antibodies. The study also set out to establish the positive diagnostic yield where biopsies were taken in the same cohort. Patients referred to Newcastle upon Tyne NHSFT adult IDA service between 2011 and 2014 identified as ttG negative and who underwent endoscopy were included. <h3>Results</h3> Two hundred patients were identified, median age 66 (range 19–91); 126 (63%) female and 74 (37%) Male. 114 (57%) patients had duodenal biopsies taken despite tTG being negative and asymptomatic. 28 (19.7%) patients were symptomatic and duodenal biopsies taken, though only 8 (28%) of these patients had 4 biopsy samples and none were from duodenal bulb. Where biopsies were taken, none confirmed coeliac disease. 5/142 (3.5%) patients biopsied had lymphocytic duodenitis but none of them were subsequently diagnosed or treated as coeliac disease. <h3>Conclusion</h3> Duodenal sampling in tTG negative patients did not yield any additional positive diagnosis of coeliac disease. This confirms the recommendations of BSG IDA guidelines. The results of this audit do not appear to support the recommendations made within the BSG coeliac disease guideline for duodenal biopsy being performed regardless of coeliac serology. However, the fact that only 4.9% of patients who had duodenal biopsies taken had duodenal bulb sampled, may limit this conclusion. More efficient use of local endsoscopy and pathology resources can occur by appropriate selection of patients on whom to perform duodenal biopsies. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Guralnik JM, Eisenstaedt RS, Ferrucci L, <i>et al</i>. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anaemia. Blood 2004;<b>104</b>:2263e8 Diagnosis and management of adult coeliac disease: Guidelines from British Society of Gastroenterology June10, 2014(10.1136/gutjnl-2013-306578) BSG Guidelines for the management of Iron deficiency anaemia May 2011

Serologic screening of celiac disease in adolescents.

This study aimed to identify the seroprevalence of celiac disease in adolescents from public schools in the city of Salvador, Bahia. This was a cross-sectional study with probabilistic sample of 1,213 adolescents, aged 11 to 17 years old, of both genders. The body mass index was used to determine the participants' nutritional status based on the percentiles for age and gender recommended by the World Health Organization. Measurement of the anti-human transglutaminase immunoglobulin A (anti-tTG-IgA) antibody was established as the specific screening test for celiac disease, which involved an enzyme-linked immunosorbent assay (ELISA). Descriptive analysis was performed using proportions and means (standard deviation). The female gender prevailed in the sample, and most of the participants had normal weights. The anti-tTG-IgA antibody was positive in 6/1,213 (0.49%) adolescents. The seroprevalence of celiac disease was 0.49% in the investigated adolescents. Further studies are necessary to establish the prevalence of celiac disease in this age range.

Tissue transglutaminase antibody levels predict IgA deficiency

ObjectiveMeasuring serum tissue transglutaminase immunoglobulin A (tTG IgA) levels is the most widely used screening test for coeliac disease. However, given an increased prevalence of IgA deficiency among coeliac patients...

Current Trends and Investigative Developments in Celiac Disease

Celiac disease has become extensively studied. What could be the cause? Increasing the accuracy of diagnostic tests for celiac disease has led to more discovered cases. Serological diagnosis of celiac disease has undergone important changes in recent years. Application of serological tests has reflected the diagnostic performance of tissue transglutaminase antibody and endomysial antibody as screening tests for celiac disease but also the progress of new serological tests as the antibodies against synthetic deamidated gliadin peptides. Serological tests are largely responsible for the recognition that celiac disease is not a rare disease. The Consensus in celiac disease from 2008 conducted under the aegis of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition jointly with North American Society of Pediatric Gastroenterology, Hepatology and Nutrition which agreed that “Celiac disease is an immune-mediated enteropathy that can affect any system or organ and that can present itself with a wide range of clinical manifestations of variable severity” was confirmed. But increasing prevalence of this disease has led to the need for new methods of treatment among patients with celiac disease. Studies on quality of life of patients with celiac disease have questioned the gluten-free diet. As such new therapies, like TG2 inhibitors, the copolymer P (HEMA-co-SS) and other new experimental therapies, have emerged in celiac disease. The new therapies in celiac disease are based on new investigations in gluten toxicity screening, like K562(S)-cell agglutination, A1 and G12 monoclonal antibodies and proteomics. In this paper we want to present the investigative developments in celiac disease. We also want to find whether a new treatment in celiac disease is necessary.

Clinical accuracy of anti‐tissue transglutaminase as screening test for celiac disease under 2 years

To investigate, in patients with suspected celiac disease (CD) younger than 2 years, the clinical value of anti-tissue transglutaminase (tTG) in diagnostic work-up of CD. Between June 2005 and June 2009, 169 patients aged <2 years, with symptoms suggestive of CD, were submitted to biopsy. CD diagnosis was based on the revised criteria of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. Of the 169 patients enrolled, 155 were included: 108 of them showed mucosal atrophy and 47 negative histology. Sensitivity and specificity of tTG, at the cut-off of 8 AU/mL, were 0.96 (CI 0.91-0.99) and 0.91 (CI 0.80-0.98), respectively, with likelihood ratio (LR) of 11.31; at the cut-off of 16 AU/mL, they were 0.79 (CI 0.70-0.86) and 1.00, respectively (CI 0.92-1.00), with LR 4.50. In patients younger than 2 years, suspected for CD, tTG is very valuable in selecting for small intestinal biopsy.

Changing Scenario in Aetiological Profile of Short Stature in India-Growing Importance of Celiac Disease: A Study from Tertiary Care Centre

To compare the etiological profile of short stature at a tertiary care hospital of North India over a decade from 1995-2007. Children attending the Post Graduate Institute of Medical Education and Research and also fulfilling the criteria for short stature over the two time periods of 1995-96 and 2005-07 were analyzed retrospectively for causes of short stature. The age group of children ranged from 10 to 15 years. Appropriate screening and definitive tests were performed to establish the etiology of short stature. In the year 1995-1996, 190 children with short stature were diagnosed. The common causes of short stature were primary hypothyroidism in 35(18.4%) followed by pituitary disorders in 29(15.2%) and nutritional disorders in 33(17.4%) while in year 2005-2007, 256 children were diagnosed with short stature. The etiology of short stature in these children were pituitary disorders in 51(19.2%) followed by celiac disease in 35(13.7%) and hypothyroidism in 35(13.7%) cases. In majority of celiac disease patients growth retardation was the presenting manifestation rather than gastrointestinal symptoms. Etiology of short stature significantly changed over a decade probably due to high index of suspicion and wide and better availability of screening tests for celiac disease. We propose all growth retarded children should be screened for celiac disease irrespective of gastrointestinal symptoms as well as periodic review of etiology of short stature.

S2039 The Sensitivity and Specificity of Deamidated Gliadin Peptide IgA and IgG as a Screening Test for Celiac Disease at the University of Virginia (UVA)

S2039 The Sensitivity and Specificity of Deamidated Gliadin Peptide IgA and IgG as a Screening Test for Celiac Disease at the University of Virginia (UVA)