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Diagnostic Accuracy of IgA Anti-Transglutaminase and IgG Anti-Deamidated Gliadin for Diagnosis of Celiac Disease in Children under Two Years of Age: A Systematic Review and Meta-Analysis. Nutrients 2021; 14:nu14010007. [PMID: 35010880 PMCID: PMC8746847 DOI: 10.3390/nu14010007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 01/18/2023] Open
Abstract
The need of adding the determination of anti-deamidated gliadin peptide (DGP) IgG to anti-transglutaminase (TTG) IgA antibodies for diagnosis of celiac disease (CD) in children <2 years of age is controversial. We performed a systematic review and meta-analysis to evaluate, by head-to-head comparison, the diagnostic accuracy of TTG IgA and DGP IgG antibodies. We searched PubMed, MEDLINE, and Embase databases up to January 2021. The diagnostic reference was intestinal biopsy. We calculated the sensitivity and specificity of these tests and the odds ratio (OR) between the tests. Fifteen articles were eligible for the systematic review and ten were eligible for the meta-analysis. Sensitivity and specificity were 0.96 (95% confidence interval (CI), 0.91–0.98) and 0.96 (95% CI, 0.85–0.99) for DGP IgG and 0.93 (95% CI, 0.88–0.97) and 0.98 (95% CI, 0.96–0.99) for TTG IgA, respectively. TTG IgA specificity was significantly higher (OR 9.3 (95% CI, 2.3–37.49); p < 0.001) while the sensitivity of DGP IgG was higher without reaching statistical significance (OR: 0.6 (95% CI, 0.24–1.51); p = 0.28). Both the meta-analysis and the systematic review showed that some children with early CD are missed without the DGP IgG test. In children <2 years of age, TTG IgA is the best CD screening test; however, the addition of DGP IgG may increase the diagnostic sensitivity.
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Maheshwari A, He Z, Weidner MN, Lin P, Bober R, Del Rosario FJ. Influence of Age and Type 1 Diabetes Mellitus on Serological Test for Celiac Disease in Children. Pediatr Gastroenterol Hepatol Nutr 2021; 24:218-229. [PMID: 33833977 PMCID: PMC8007846 DOI: 10.5223/pghn.2021.24.2.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/12/2020] [Accepted: 10/03/2020] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Serological tests of tissue transglutaminase (TTG) and deamidated gliadin (DGP) antibodies for celiac disease diagnosis show conflicting correlation with histology in young children and in type 1 diabetes mellitus (T1DM). Tests' ability to predict histology and cutoff values based on age and T1DM was evaluated. METHODS A retrospective study of children who had celiac serological tests between 6/1/2002 and 12/31/2014 at a pediatric hospital. RESULTS TTG IgA displayed similar results in predicting histology between <4.0 and ≥4.0 years age groups with sensitivity 98% and 93%, and specificity 88% and 86%, respectively. In children <4.0 years old, sensitivity for DGP antibodies was 100% and specificity 94%; in ≥4.0 years age groups, sensitivity was 60%, 88% for DGP IgA and IgG and specificity 95%, 96%, respectively. TTG IgA had low specificity in patients with T1DM compared with non-T1DM, 42% vs. 91%. Positive TTG IgA with normal histology was associated with higher T1DM prevalence at 36% compared with negative tests at 4%. Finally, the TTG IgA cutoff value was higher in T1DM at 36 vs. 16.3 units in non-T1DM. DGP IgG cutoff showed similar values between age groups; TTG IgA and DGP IgA cutoffs were lower in <4.0 years at 8.3 and 11.9 units than ≥4.0 years at 23.4 and 19.9, respectively. CONCLUSION TTG IgA is sufficient for the <4.0 years age group and DGP antibodies had no advantage over TTG IgA in older children. The cutoff value to determine a positive TTG IgA should be higher for children with T1DM.
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Affiliation(s)
- Anshu Maheshwari
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.,Department of Pediatrics, Sidney Kimmel College of Medicine, Philadelphia, PA, USA.,Department of Pediatrics, University of Illinois College of Medicine in Peoria and Children's Hospital of Illinois, Peoria, IL, USA
| | - Zhaoping He
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.,Department of Pediatrics, Sidney Kimmel College of Medicine, Philadelphia, PA, USA
| | - Melissa Nicole Weidner
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.,Department of Pediatrics, Sidney Kimmel College of Medicine, Philadelphia, PA, USA.,Department of Pediatrics, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Patrick Lin
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.,Department of Pediatrics, Sidney Kimmel College of Medicine, Philadelphia, PA, USA.,Department of Pediatrics, Lehigh Valley Reilly Children's Hospital, Allentown, PA, USA
| | - Ryan Bober
- Department of Pediatrics, Sidney Kimmel College of Medicine, Philadelphia, PA, USA.,Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Fernando J Del Rosario
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.,Department of Pediatrics, Sidney Kimmel College of Medicine, Philadelphia, PA, USA
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Saadah OI, Alamri AM, Al-Mughales JA. Deamidated gliadin peptide and tissue transglutaminase antibodies in children with coeliac disease: A correlation study. Arab J Gastroenterol 2020; 21:174-178. [PMID: 32732170 DOI: 10.1016/j.ajg.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 07/04/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND STUDY AIMS Serological tests for coeliac disease (CD) are important in the clinical diagnosis and monitoring of response to a gluten free diet (GFD). The tests differ in their sensitivity, specificity, and diagnostic accuracy. In this study, tissue transglutaminase (IgA) (tTG-IgA) antibody was compared with the deamidated gliadin peptide (DGP), of both IgG (DGP-IgG) and IgA (DGP-IgA) types, in patients with CD. PATIENTS AND METHODS This cross-sectional study was conducted over a period of 2 years, between 2016 and 2018, at King Abdulaziz University Hospital in children 18 years of age or younger with biopsy-proven CD. Patients' sera were tested for DGP-IgA, DGP-IgG, and tTG-IgA antibodies using enzyme-linked immunosorbent assay (ELISA). A Pearson correlation coefficient and Cohen's kappa coefficient were performed to analyse the serological tests. RESULTS The study included 26 patients with CD, with a median age of 15 years (range, 5-18 years). Seventeen patients (65.4%) were males. The median disease duration was 5 years (range, 3-14 years). Fifteen patients (57.7%) reported good adherence to a GFD. The patients' serological tests showed a mean ± SD tTG-IgA titer of 149.8 ± 75 u/ml, a mean DGP-IgG titer of 62.5 ± 36.5, and a mean DGP-IgA of 32 ± 23.3 μ/ml. We found a significant correlation between tTG-IgA and DGP-IgG (r = 0.69, P < 0.001), tTG-IgA and DGP-IgA (r = 0.67, P < 0.001), and DGP-IgG and DGP-IgA (r = 0.83, P < 0.001). Cohen's kappa coefficient (k) showed substantial agreement between tTG-IgA and DGP-IgG (k = 0.71, P < 0.001) and DGP-IgG and DGP-IgA (k = 0.69, P < 0.001), but moderate agreement between tTG-IgA and DGP-IgA (k = 0.45, P = 0.006). CONCLUSION We found a good correlation between tTG-IgA and DGP-IgG and tTG-IgA and DGP-IgA, and substantial agreement between tTG-IgA and DGP-IgG, but moderate agreement between tTG-IgA and DGP-IgA. These results indicate that DGP-IgG was comparable to tTG-IgA and may be useful as an alternative to tTG-IgA in the diagnosis and follow-up of patients with CD.
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Affiliation(s)
- Omar I Saadah
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Aisha M Alamri
- Deparrtment of Pediatrics, East Jeddah General Hospital, Jeddah, Saudi Arabia
| | - Jamil A Al-Mughales
- Department of Clinical Laboratory Medicine and Diagnostic Immunology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia; Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Rintala A, Riikonen I, Toivonen A, Pietilä S, Munukka E, Pursiheimo JP, Elo LL, Arikoski P, Luopajärvi K, Schwab U, Uusitupa M, Heinonen S, Savilahti E, Eerola E, Ilonen J. Early fecal microbiota composition in children who later develop celiac disease and associated autoimmunity. Scand J Gastroenterol 2018; 53:403-409. [PMID: 29504486 DOI: 10.1080/00365521.2018.1444788] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Several studies have reported that the intestinal microbiota composition of celiac disease (CD) patients differs from healthy individuals. The possible role of gut microbiota in the pathogenesis of the disease is, however, not known. Here, we aimed to assess the possible differences in early fecal microbiota composition between children that later developed CD and healthy controls matched for age, sex and HLA risk genotype. MATERIALS AND METHODS We used 16S rRNA gene sequencing to examine the fecal microbiota of 27 children with high genetic risk of developing CD. Nine of these children developed the disease by the age of 4 years. Stool samples were collected at the age of 9 and 12 months, before any of the children had developed CD. The fecal microbiota composition of children who later developed the disease was compared with the microbiota of the children who did not have CD or associated autoantibodies at the age of 4 years. Delivery mode, early nutrition, and use of antibiotics were taken into account in the analyses. RESULTS No statistically significant differences in the fecal microbiota composition were found between children who later developed CD (n = 9) and the control children without disease or associated autoantibodies (n = 18). CONCLUSIONS Based on our results, the fecal microbiota composition at the age of 9 and 12 months is not associated with the development of CD. Our results, however, do not exclude the possibility of duodenal microbiota changes or a later microbiota-related trigger for the disease.
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Affiliation(s)
- Anniina Rintala
- a Department of Medical Microbiology and Immunology , University of Turku , Turku , Finland.,b Department of Clinical Microbiology , Turku University Hospital , Turku , Finland
| | - Iiris Riikonen
- a Department of Medical Microbiology and Immunology , University of Turku , Turku , Finland
| | - Anne Toivonen
- c Department of Bacteriology and Immunology , University of Helsinki and Laboratory Services (HUSLAB), Division of Clinical Microbiology, Helsinki University Hospital , Helsinki , Finland.,d Department of Clinical Microbiology , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
| | - Sami Pietilä
- e Turku Centre for Biotechnology , University of Turku and Åbo Akademi University , Turku , Finland
| | - Eveliina Munukka
- a Department of Medical Microbiology and Immunology , University of Turku , Turku , Finland
| | | | - Laura L Elo
- e Turku Centre for Biotechnology , University of Turku and Åbo Akademi University , Turku , Finland
| | - Pekka Arikoski
- g Department of Pediatrics , Kuopio University Hospital and University of Eastern Finland , Kuopio , Finland
| | - Kristiina Luopajärvi
- h Children's Hospital, Department of Pediatrics , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
| | - Ursula Schwab
- i Institute of Public Health and Clinical Nutrition , University of Eastern Finland , Kuopio , Finland
| | - Matti Uusitupa
- i Institute of Public Health and Clinical Nutrition , University of Eastern Finland , Kuopio , Finland
| | - Seppo Heinonen
- j Department of Obstetrics and Gynecology , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
| | - Erkki Savilahti
- h Children's Hospital, Department of Pediatrics , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
| | - Erkki Eerola
- a Department of Medical Microbiology and Immunology , University of Turku , Turku , Finland.,b Department of Clinical Microbiology , Turku University Hospital , Turku , Finland
| | - Jorma Ilonen
- a Department of Medical Microbiology and Immunology , University of Turku , Turku , Finland.,k Immunogenetics Laboratory , Institute of Biomedicine, University of Turku , Turku , Finland
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Arigliani M, Rech Morassutti F, Fabris M, Melli P, Tonutti E, Cogo P. Coeliac disease in infants: antibodies to deamidated gliadin peptide come first! Ital J Pediatr 2017; 43:70. [PMID: 28797308 PMCID: PMC5553580 DOI: 10.1186/s13052-017-0392-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/03/2017] [Indexed: 12/15/2022] Open
Abstract
Background The onset of coeliac disease (CD) in the first year of life is uncommon and the diagnosis can be challenging due to the suboptimal sensitivity of tissue transglutaminase antibodies (tTG) at this age and the many other possible causes of malabsorption in infants. Antibodies to deamidated gliadin peptides (anti-DGPs), especially IgG, may appear earlier than IgA anti-tTG in very young children with CD. Case presentation We report here on an 8-month-old child who was evaluated for failure to thrive, constipation and developmental delay. The symptoms started following gluten introduction in the diet. Laboratory tests showed high fecal elastase concentration, normal serum IgA levels with positive IgG and IgA anti-DGPs, whereas anti-tTG were not detected. The duodenal biopsy revealed a complete villous atrophy (Marsh-Oberhuber 3C). The culture of biopsy fragments in the presence of gliadin peptides did not stimulate the production of IgA anti-endomysial antibodies. Genetic testing proved the child was positive for HLA-DQ2 (DQA1*05; DQB1*02) and HLA-DQ8 (DQA1*03, DQB1*0302). Having initiated the gluten-free diet, the symptoms disappeared and the infant experienced rapid catch-up growth with normalization of psychomotor development. Conclusions This case report highlights the utility of anti-DGPs for screening infants with suspected CD. The pattern with positivity for IgG and IgA anti-DGPs only is rare in IgA-competent children with biopsy-proven CD. It could be explained in infancy as immaturity of the adaptive immune system.
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Affiliation(s)
- Michele Arigliani
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, Piazzale S. Maria Misericordia 1, 33100, Udine, Italy.
| | - Francesca Rech Morassutti
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, Piazzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Martina Fabris
- Department of Laboratory Medicine, Institute of Clinical Pathology, University Hospital of Udine, Udine, Italy
| | - Paola Melli
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, Piazzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Elio Tonutti
- Department of Laboratory Medicine, Institute of Clinical Pathology, University Hospital of Udine, Udine, Italy
| | - Paola Cogo
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, Piazzale S. Maria Misericordia 1, 33100, Udine, Italy
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