CM Trovato et al JPGN 2021; 72: 712-717. Diagnostic Value of Persistently Low Positive TGA-IgA Titers in Symptomatic Children With Suspected Celiac Disease
This retrospective study provides insight into the predictive value of persistently abnormal celiac labs in symptomatic children.
Inclusion criteria: not eligible for a non-biopsy diagnosis AND children with at least 2 TGA-IgA measurements, endomysial antibody (EMA) assessment and esophagogastroduodenoscopy with biopsies
Methods: Patients were classified in groups according to median TGA-IgA values: Group A (TGA-IgA>1 ≤ 5 × ULN; defined as “low-positive”), Group B (TGA-IgA > 5 < 10 × ULN; “moderate-positive”), and C (controls).
- In group A, CD was diagnosed in 142/162 (87.7%)
- In group B, all 62 children (100%) received a CD diagnosis
My take: In individuals with mild elevation of celiac serology, it is reasonable to recheck prior to confirming with endoscopy. However, those with persistently abnormal values are very likely to have celiac disease.
Related blog posts:
- Celiac Titers and Likelihood of Celiac Disease | gutsandgrowth This study found the following:
- If TTG IgA at 1-fold ULN, then PPV 61%, NPV 98%, Sens 90%, Spec 90%
- If TTG IgA at 2-fold ULN, then PPV 79%, NPV 97%, Sens 82%, Spec 96%
- If TTG IgA at 5-fold ULN, then PPV 93%, NPV 94%, Sens 62%, Spec 99%
- If TTG IgA at 7-fold ULN, then PPV 96%, NPV 91%, Sens 41%, Spec 100%
- Best Screening For Celiac At All Ages | gutsandgrowth
- How Likely is Celiac Disease if My TTG Test Is Only a Little Bit Abnormal? | gutsandgrowth
- Celiac Disease: “Ten Things That Every Gastroenterologist Should Know” | gutsandgrowth
- Will Asymptomatic Patients with “Potential” Celiac Disease Benefit from a Gluten-free Diet? | gutsandgrowth
- Nuance in Celiac Serology
- “To biopsy or not to biopsy” –that is the question (for Celiac disease) | gutsandgrowth