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Does IgA tTG Predict Mucosal Recovery in Children with Celiac Disease on a Gluten Free Diet?

Nearly one in five children with celiac disease in one study population had persistent enteropathy, despite maintaining a gluten free diet.


Photo: CC--Julian Fong

Celiac.com 01/23/2017 - It makes some kind of sense that kids with celiac disease who follow a gluten-free diet will recover, their guts will normalize, and their levels of IgA tissue transglutaminase antibodies would drop to reflect this change; whereas high antibodies likely mean no recovery, right? But is that true? Is there really a correlation on any level?

To test this idea, a team of researchers recently set out to document the rate of mucosal recovery in kids with celiac disease on a gluten-free diet. They also wanted to figure out whether IgA tissue transglutaminase (tTG) correlates with mucosal damage at the time of a repeat endoscopy with duodenal biopsy.

The research team included Maureen M. Leonard, Dascha C. Weir, Maya DeGroote, Paul D. Mitchell, Prashant Singh, Jocelyn A. Silvester, Alan M. Leichtner, and Alessio Fasano.

Their team conducted a retrospective chart review of one-hundred and three pediatric patients, under 21 years of age, with a diagnosis of celiac disease defined as Marsh 3 histology, and who underwent a repeat endoscopy with duodenal biopsy at least twelve months after initiating a gluten free diet.

Their result showed that 19% of these pediatric patients treated with a gluten-free diet still had persistent enteropathy.

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At the time of the repeat biopsy, tTG was elevated in 43% of cases with persistent enteropathy, and in 32% of cases in which there was mucosal recovery. So, high tTG levels could be seen in both recovered patients, and non-recovered patients.

The overall positive predictive value of the autoantibody tissue transglutaminase was 25%, and the negative predictive value was 83%, in patients on a gluten free diet for a average of 2.4 years.

Nearly one in five children with celiac disease in this study population had persistent enteropathy, even with a gluten free diet. Also, IgA tTG was not an accurate marker of mucosal recovery. Neither the presence of symptoms, nor positive serology predicted a patient's histology at the time of repeat biopsy.

These findings could help improve current monitoring and management criteria of celiac disease in children.

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