Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Influence of Age and Type 1 Diabetes Mellitus on Serological Test for Celiac Disease in Children

  • Maheshwari, Anshu (Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition/Alfred I. duPont Hospital for Children) ;
  • He, Zhaoping (Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition/Alfred I. duPont Hospital for Children) ;
  • Weidner, Melissa Nicole (Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition/Alfred I. duPont Hospital for Children) ;
  • Lin, Patrick (Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition/Alfred I. duPont Hospital for Children) ;
  • Bober, Ryan (Department of Pediatrics, Sidney Kimmel College of Medicine) ;
  • Del Rosario, Fernando J. (Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition/Alfred I. duPont Hospital for Children)
  • Received : 2020.04.30
  • Accepted : 2020.10.03
  • Published : 2021.03.15
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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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References

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