The Connection Between Anti-Tissue Transglutaminase Antibodies and Intestinal Mucosal Damage in Children with Celiac Disease

Celiac.com 02/06/2023 - Typically, doctors diagnose celiac disease using serological markers, like anti-tissue transglutaminase antibodies (t-TGA), along with a biopsy of the small bowel (SBB) to spot mucosal damage in the gut.

To get a better understanding of the connection between serological markers and changes to gut mucosa in children with celiac disease, a team of researchers recently examined the connection between serological markers, and changes of the intestinal mucosa in children with celiac disease. To do so, they used data from a national Spanish registry, called REPAC-2, that included children under 15 years old. The wanted to determine the potential connection between t-TGA levels and other factors, such as mucosal damage and clinical findings, based on gender, age, symptoms.

The study included nearly 5,000 patients with celiac disease, nearly 3,000 of whom underwent both t-TGA and a SBB for diagnosis. 

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The results showed that more than two-thirds of the patients with normal IgA values had a Marsh 3b-c lesion, which is a severe form of mucosal damage, and nearly as many had t-TGA IgA levels at or above 10 times the upper limit of normal (ULN). The study found a statistically significant association between t-TGA IgA levels and the degree of mucosal damage. The higher the t-TGA IgA levels, the more severe the mucosal damage.

Among other things, the study found that patients who reported symptoms had more severe mucosal damage compared to those who did not. 

They also found a negative association between age and changes of the intestinal mucosa, which suggests that younger patients are more likely to suffer severe mucosal damage. But, the team found no connection between gender and changes to gut mucosa.

The study included a subgroup of 18 IgA-deficient patients. The results showed that nearly half of these patients had t-TGA IgA levels at or above 10 times ULN, while nearly seventy percent had Marsh 3b-c lesions. 

The team found no significant connection between t-TGA IgG levels and changes to gut mucosa, including for factors like age, gender, or symptom type.

The results of this study suggest a positive association between t-TGA IgA levels and the degree of gut mucosal changes in children with celiac disease. However, they found no association in IgA-deficient patients with positive t-TGA IgG results. 

These findings echo the recommendations of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN), which advises SBB in IgA-deficient patients, even with high t-TGA IgG readings.

The study reinforces the practice of factoring in both t-TGA IgA and IgG levels, as well as conducting a small bowel biopsy, when diagnosing celiac disease in children, especially in those with IgA deficiency, regardless of t-TGA IgG levels.  

Studies like this are helpful for getting clinicians and primary care physicians on the same page about best practices for celiac diagnosis in children.

However, there is still much to be discovered about the relationship between serological markers and changes to gut mucosa in celiac patients. Stay tuned for more on this and related topics.

Read more in the Journal of Pediatric Gastroenterology & Nutrition