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

Pediatrics 2005;115:1341-1346.

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.

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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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3 Responses:

 
Kerri Harrell
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said this on
27 Oct 2007 9:45:47 PM PDT
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.

 
khalaf
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said this on
30 May 2008 12:26:51 PM PDT
Really this is very interesting and may help a lot of people.

 
Norm
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said this on
18 Jun 2009 11:51:56 AM PDT
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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I use almond, and coconut a lot now my bakery used to use oat and almond blends. We never used rice, or starches as our goal was to keep it low glycemic. Now days we are transitioning to cut out oats. I started having....ok I omitted and gave in after being in denial a similar reaction to oats (10% of celiacs do if I recall) over a year ago. Anyway as for flour blends premade avoiding rice and grains try simple mills at https://www.simplemills.com/collections/all I have composed a huge list of various gluten-free goods here, even recently updated with grain free, and pizza section https://www.celiac.com/gluten-free/topic/117090-gluten-free-food-alternatives-list/

Hello Everyone, New here and have joined because I couldn't find an answer to my question online. I was diagnosed after a long spell with anemia in 2015 and have been on the diet (and improving!) ever since. But I wonder whether how much rice I'm eating is very healthy. I have always liked to bake and it took awhile to find a flour mix I like (Cup 4 Cup - worth its weight in gold...), but a lot of gluten-free food subs in rice (white rice, brown rice, rice flour) plus I eat actual rice as a side dish. Is this too much? Keep in mind, I also eat salads like it's my job and love making vegetable soups too. Any advice on gluten-free foods (specifically flours) that don't fall back on rice as a substitute? I should add that I can't really get excited about quinoa, despite my best efforts. Thanks in advance.

I would say get retested, to be sure, do a gluten challenge with her where she eats gluten for 12 weeks, not much just a half slice of bread a day or a wheat cracker for the blood test and 2 weeks for the biopsy. You mentioned bumps, and dry patches...this might be DH from celiacs and if it is you can go to a dermatologist and they can test it. In some people with DH reactions to gluten, their intestines do not show much damage as most of the antibodies are directed elsewhere. In this case you would have your symptoms. Now Celiac is a autoimmune disease that commonly has other auto immune diseases associated with it. NOW if your daughter has the gene for it she could have another automimmune disease I am not very familiar with and someone else might be able to help you more on suggestions for testing. Now in my personal opinion it sounds like she was still getting into gluten when you said she was off of it. NOTE gluten is a tricky bugger, it is a protein smaller then a germ that can stick in cracks and scratches on all your utensils, food prep area, knifes, etc. As a flour it can hang in the air for hours and even be inhaled effecting some of us. It is present in a lot of things we do not consider, like makeup, playdough, shampoos, seasonings, sauces, even some dry wall spackles. Now if she is in a shared house hold with other kids and not everyone is on this diet she has likely been getting into gluten somewhere, like touching glutened surfaces the other kids touched after eating gluten foods then putting her hand in her mouth or on safe foods. Or just randomly eating gluten foods, note symptoms can last weeks and wane from how it is effecting you. It does not take much to trigger symptoms you might have to be more careful and move her to a whole foods only diet, and have a separate prep area, utensils, cooking zone for her if you wish to keep fixing separate meals for her vs the gluten family. I would suggest just changing the entire family over, anyway perhaps start with a separate fold out table, use freezer paper to line the prep area, a microwave, mini toaster oven, and some microwave cook ware like steamers, steam bags, etc. and using gloves to fix her meals. She will need her own condiment jars (crumbs in hte jars) and area for safe snacks. I would suggest getting her only gluten-free CERTIFIED FOODS for now. You can find some whole food healthy snacks at mygerbs.com, and a few other places. I will provide a link to gluten-free food list. PERHAPS you can change the entire family over....now days it is more like changing brands as everything you used to eat is available in a gluten-free brand. ALSO have a lot of dairy free options there. https://www.celiac.com/gluten-free/topic/117090-gluten-free-food-alternatives-list/

Hi wondering if someone could help. my daughter has mildly raised TTG levels and the gliadine levels, she has one Coeliacs gene, but her biopsy came back negative. We have kept her off gluten (and low dairy) for nearly a year to see if her symptoms improved. They haven't. But I don't know if they are related to gluten specifically. Just wondering if anyone has other suggestions that may be going on with her. Her symptoms are: - Short stature, she's nearly 9 and my 6 year old boy is nearly bigger than her - bumps on back of her arms - urine leaking and occasional soiled pants, which could be from constipation she has at time's - sticking out stomach - dry patchy rashes on her face - joint pain sporadically - vomits every 6 weeks, but hasn't had gluten and seems to be no food connection - reoccurring thrush She had gluten last night at a party and was fine today. I'm a bit lost and not sure where else to turn. Thanks for any help.

We have gone gluten free, our whole house, as of a month ago. It was pretty seamless since I had been gluten-free for 5 months last year. I have found many good recipes, and my picky husband and one of my boys who is also a picky eater, even prefer many gluten-free recipes to the regular ones. My husband did see my point about the size of the gluten protein means nothing. Its a gluten protein period, that's what you are avoiding. It doesn't matter if its hiding in the scratch of your baking sheet and you can't see it. You can't see the wind, but it's still there. I hear you on the anemia. I've been anemic for several years, I just thought it as because I was getting a little older. Has your anemia gone away or do you still have problems with it?