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    Scott Adams

    Tissue Transglutaminase Antibody Screening May Replace the Biopsy in the Diagnosis of Celiac Disease

    Scott Adams
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    Reviewed and edited by a celiac disease expert.

    Pediatrics 2005;115:1341-1346.



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    Celiac.com 05/31/2005 – According to Canadian researchers, the use of Tissue Transglutaminase Antibody (tTG) Screening may soon replace the use of the small bowel biopsy to diagnose celiac disease in children. The researchers reviewed the charts of 103 children who were screened for celiac disease using both small bowel biopsy and tTG. Fifty-eight of the children were found to have positive biopsy results, and out of these, 48 had very high tTG levels (over 100 U), 7 had middle tTG levels (20-100 U), and 3 had low levels (less than 20 U). Out of the 49 children with the highest tTG levels, all but one of them had a positive biopsy result. There were 3 biopsy-positive children who had low tTG levels, two who were found to be IgA negative, and one who had a duodenal ulcer.

    According to the researchers, using tTG values of greater than 100 U and less than 20 U, and knowing the patients IgA status, tTG testing was "98% sensitive and 97% specific in detecting celiac disease." The researchers also point out that the cost of diagnosis could be cut by 30% by utilizing tTG screening. The researchers conclude that children with high tTG titers can proceed straight to a gluten-free diet--if they respond well then their diagnosis is confirmed—if not they can proceed to a biopsy.

    Although the authors dont address this issue specifically, this method would likely lead to an increase in the diagnosis rate of celiac disease, as many people are unwilling to undergo a biopsy--or have their children undergo one.

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    I had a ttg level of 57, symptoms for almost 10 years, genetic link with my father and after being on the gluten-free diet for two weeks, my sacral-iliac joint pain that I had for 4 years vanished. My biopsy was negative! Since the diet, I have tested the waters by eating pizza or donuts and have been sick for weeks with just a little exposure. No doubt in my case, the biopsy was not necessary and actually complicated what was already a sure thing.

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    I agree that screening is helpful this way and certainly less costly and more convenient. What needs to happen however it to have a test that confirms the screen since you can still have falsely positive screen and subsequently you may be relegated to a lifetime of a gluten free diet that is not always easy to do. Celiac sprue can present in the small bowel as patchy areas therefore biopsies should be plentiful and more rigorous.

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  • About Me

    Scott Adams was diagnosed with celiac disease in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. In 1995 he launched the site that later became Celiac.com to help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives.  He is co-author of the book Cereal Killers, and founder and publisher of the (formerly paper) newsletter Journal of Gluten Sensitivity. In 1998 he founded The Gluten-Free Mall which he sold in 2014. Celiac.com does not sell any products, and is 100% advertiser supported.


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