Duodenal biopsy may be avoided when high transglutaminase antibody titers are present  

作　　者：Santiago Vivas Jose G Ruiz de Morales Sabino Riestra Laura Arias Dolores Fuentes Noemi Alvarez Sara Calleja Mercedes Hernando Blanca Herrero Javier Casqueiro Luis Rodrigo 

机构地区：[1]Department of Gastroenterology,Hospital de León [2]Institute of Biomedicine,University of León [3]Immunology Section,Hospital de León [4]Department of Gastroenterology,Hospital Universitario Central de Asturias [5]Department of Pathology,Hospital de León [6]Department of Pediatrics,Hospital de León [7]Faculty of Biology and Environmental Sciences,University of León

出　　处：《World Journal of Gastroenterology》2009年第38期4775-4780,共6页世界胃肠病学杂志（英文版）

基　　金：Supported by A grant of the Instituto de Salud Carlos Ⅲ (FIS ref. PI070611);by a grant of the Junta de Castillay León,Consejería de Sanidad (Ref 318/A/08)

摘　　要：AIM:To evaluate the predictive value of tissue transglutaminase (tTG) antibodies for villous atrophy in adult and pediatric populations to determine if duodenal biopsy can be avoided.METHODS: A total of 324 patients with celiac disease (CD; 97 children and 227 adults) were recruited prospectively at two tertiary centers. Human IgA class anti-tTG antibody measurement and upper gastrointestinal endoscopy were performed at diagnosis. A second biopsy was performed in 40 asymptomatic adults on a gluten-free diet (GFD) and with normal tTG levels.RESULTS: Adults showed less severe histopathology (26% vs 63%, P<0.0001) and lower tTG antibody titers than children. Levels of tTG antibody correlated with Marsh type in both populations (r=0.661, P<0.0001). Multiple logistic regression revealed that only tTG antibody was an independent predictor for Marsh type 3 lesions, but clinical presentation type and age were not. A cut-off point of 30 U tTG antibody yielded the highest area under the receiver operating characteristic curve (0.854). Based on the predictive value of this cut-off point, up to 95% of children and 53% of adults would be correctly diagnosed without biopsy. Despite GFDs and decreased tTG antibody levels, 25% of the adults did not recover from villous atrophy during the second year after diagnosis.CONCLUSION: Strongly positive tTG antibody titers might be sufficient for CD diagnosis in children. However, duodenal biopsy cannot be avoided in adults because disease presentation and monitoring are different.AIM： To evaluate the predictive value of tissue transglutaminase （tTG） antibodies for villous atrophy in adult and pediatric populations to determine if duodenal biopsy can be avoided. METHODS： A total of 324 patients with celiac disease （CD; 97 children and 227 adults） were recruited prospectively at two tertiary centers. Human IgA class anti-tTG antibody measurement and upper gastrointestinal endoscopy were performed at diagnosis. A second biopsy was performed in 40 asymptomatic adults on a gluten-free diet （GFD） and with normal tTG levels. RESULTS： Adults showed less severe histopathology （26% vs 63%; P 〈 0.0001） and lower tTG antibody titers than children. Levels of tTG antibody correlated with Marsh type in both populations （r = 0.661; P 〈 0.0001）. Multiple logistic regression revealed that only tTG antibody was an independent predictor for Marsh type 3 lesions, but clinical presentation type and age were not. A cut-off point of 30 U tTG antibody yielded the highest area under the receiver operating characteristic curve （0.854）. Based on the predictive value of this cut-off point, up to 95% of children and 53% of adults would be correctly diagnosed without biopsy. Despite GFDs and decreased tTG antibody levels, 25% of the adults did not recover from villous atrophy during the second year after diagnosis. CONCLUSION： Strongly positive tTG antibody titers might be sufficient for CD diagnosis in children. However, duodenal biopsy cannot be avoided in adults because disease presentation and monitoring are different.

关 键 词：BIOPSY Celiac disease Diagnosis DUODENUM TRANSGLUTAMINASES 

分 类 号：R446.6[医药卫生—诊断学]