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Asymptomatic Children Might Not Need Biopsy for Celiac Diagnosis

Celiac.com 11/10/2015 - Doctors might not need a biopsy to accurately diagnose celiac disease in asymptomatic children who have elevated anti-tTG, according to the latest study.

Photo: CC--Adrian ClarkIn that study, researchers in Italy evaluated a new biopsy-sparing protocol for diagnosing celiac disease in symptomatic children with high anti-transglutaminase (anti-tTG). Their data showed that this approach might also work in asymptomatic children with elevated antibody levels.

In 2012, the European Society of Pediatric Gastroenterology, Hematology, and Nutrition (ESPGHAN) published guidelines that said biopsies could be omitted in children and adolescents with signs and symptoms of celiac disease if they met certain guidelines.

Dr. Francesco Valitutti of Rome's Sapienza University led a team that set out to assess the accuracy of serological tests to diagnose celiac disease in asymptomatic patients in 286 children and adolescents who had been diagnosed with celiac disease.

Among 196 patients with anti-tTG antibodies at least 10 times ULN and EMA positive, 156 had symptoms and 40 were asymptomatic. More than 90% of the symptomatic children (142/156, 91%) showed severe lesion degree on biopsy, and an even higher percentage of asymptomatic patients (37/40, 92.5%) had severe lesions.

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There was no significant difference in histological damage between the "high-titer" symptomatic and asymptomatic children, according to the September 15th online report in The American Journal of Gastroenterology. Among the EMA positive children with lower titers of anti-tTG antibodies, 70% of symptomatic children and 81% of asymptomatic children showed severe lesions.

The researchers add that asymptomatic patients should follow a gluten-free diet "as strictly as symptomatic ones, in order to prevent other autoimmune diseases and enteropathy-associated T-cell lymphoma."

Otherwise, the new guidelines apply to patients with: TTG > 10 times ULN; an EMA of at least 1:80; a positive repeat serology to exclude laboratory error; HLA-DQ2 and/or -8 positivity; and a serological response to a gluten-free diet.

If the research team can confirm these results in larger, multi-center prospective studies, their 'biopsy-sparing' protocol might be made available "to both symptomatic and asymptomatic patients with anti-tTG antibody titer (at least) 10 times the upper limit of normal (ULN) and anti-endomysial antibodies (EMA) and HLA-DQ2/DQ8 positive," Dr. Valitutti told reporters.

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1 Response:

 
Siobhan Coplin
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said this on
22 Aug 2016 8:06:14 PM PDT
I have Celiac Disease and I am a double carrier confirmed by a biopsy as well. Can my son do a mouth swab for the genetic testing instead of blood work? Thank you very much.




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Want a quick, tasty stir-fry that is almost certain to please? This recipe combines tender, juicy shrimp with sesame oil, spices, vegetables, and teriyaki sauce, to make a delightful gluten-free meal. Shrimp, sesame oil, spices and and vegetables make a great stir-fry meal. View the full article

Thank you for trying Kerry! I was unable to open the link though. Another celiac.com page pops up telling me I do not have an account for it.

I don't use these things they are usually sodium bombs!

I don't Usually use the super processed stuff, which this is. I use the spices or the gluten free spice mixes. I assume maybe something just didn't set well but I doubt it's gluten because I believe they're reputable. My husband doesn't have celiac and said his tummy is weird too, so I doubt it's gluten. I'll call them today to be sure.

I use them, too.