Multiplex TGA Blood Test Accurately Diagnoses Pediatric Celiac Disease in Real World Conditions

Celiac.com 06/06/2022 - Researchers have shown that tissue-transglutaminase antibodies (TGA) can be used to diagnose celiac disease without biopsy, but there's no good data on how accurate it is in real life conditions.

A team of researchers recently set out to investigate real-life performance of a Bioplex2200 automated celiac serology analyzer, and to explore the correlation between tissue-transglutaminase antibody levels and intestinal biopsies in children.

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The research team included Anat Guz-Mark; Michal Kori; Chani Topf-Olivestone; Ronit Weinberger; Sara Morgenstern; Nadya Ziv-Sokolovskaya; and Raanan Shamir.

They are variously affiliated with the Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva; the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv; the Pediatric Gastroenterology, Kaplan Medical Center, Rehovot; the Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem; the Immunology Laboratory, Clalit Health Services, Tel Aviv; the Institute of Pathology, Rabin Medical Center, Pitach-Tikva; and the Institute of Pathology, Kaplan Medical Center, Rehovot, Israel.

The team conducted a retrospective review in two pediatric gastroenterological centers, between November 1, 2018 and April 1, 2020. They included patients with both tissue-transglutaminase antibody serology testing and duodenal biopsies. They gathered data including patient demographics, medical background, TGA levels, and biopsy results.

In all, the team looked at 538 children. They found 256 with positive tissue-transglutaminase antibodies, and 282 with negative tissue-transglutaminase antibodies. Among patients with positive tissue-transglutaminase antibodies, intestinal biopsies confirmed celiac disease in 219, or nearly 86% of cases.

The team found positive serology with normal histology in about fifteen percent of the cases. In more than half, they found tissue-transglutaminase antibody ranges of 1 to 3 times upper limit of normal. About twenty percent had tissue-transglutaminase antibody ranges 3 to 5 times upper limit of normal; about twenty percent had tissue-transglutaminase antibody ranges 5 to 10 times upper limit of normal; and just over 4% had tissue-transglutaminase antibody ranges above 10 times upper limit of normal, respectively.

Nearly eighty-five percent of patients with positive tissue-transglutaminase antibodies also had positive anti-endomysial antibodies. However, overall diagnostic performance in these patients was inferior.

The team found that the Multiplex tissue-transglutaminase antibody assay accurately diagnosed celiac disease in real world conditions. EMA screening did not improve the diagnostic accuracy in patients with positive tissue-transglutaminase antibodies.

Meanwhile, false-positives varied depending on tissue-transglutaminase antibody range, but were low in patients with tissue-transglutaminase antibody levels above 10 times upper limit of normal.

The ability to use multiplex tissue-transglutaminase antibodies for accurate celiac diagnosis offers clinicians another cheap and easy tool for catching celiac disease early. The easier and cheaper it becomes to diagnose celiac disease, and the earlier it can be caught, the more long term damage can be avoided for celiac sufferers.

Read more in the Journal of Pediatric Gastroenterology and Nutrition