Antitissue transglutaminase antibody determination versus upper endoscopic biopsy diagnosis of paediatric celiac disease

Abstract

Background: European guidelines question the requirement for intestinal biopsies to diagnose celiac disease in children. Objective: To determine the specificity of serological diagnosis of celiac disease (CD) using antitissue transglutaminase antibody (aTTG) levels in a general pediatric referral population. Methods: Children referred from 2005 to 2008 with a positive aTTG test were included, regardless of symptoms. Diagnostic endoscopy was performed and a minimum of six biopsies were obtained. Histological samples were reviewed in a blinded manner, and specificities and sensitivities of aTTG threshold levels for a diagnostic Marsh score ≥3 were determined. Results: A total of 115 eligible patients were identified, 73% of whom had a Marsh score ≥3. The specificity of an aTTG level of ≥100 U/mL was 97% (95% CI 93.5% to 100%); an aTTG level ≥200 U/mL was 100% (95% CI 89% to 100%) specific. Conclusion: Further research is required before considering a change in diagnostic standards in Canada. In this region, the threshold aTTG level to provide diagnostic specificity of 100% is significantly greater than the threshold aTTG level being proposed for diagnosis in Europe. © 2013 Pulsus Group Inc. All rights reserved.