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Antibodies Against Deamidated Gliadin Peptides and Tissue Transglutaminase for Diagnosis of Pediatric Celiac Disease - Diagnostic Performance and Cost in Clinical Practice.
MedLine Citation:
PMID:  22722680     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES:: To evaluate diagnostic performance and actual costs in clinical practice of IgG/IgA deamidated gliadin peptide antibodies (DGP) as a complement to IgA antibodies against tissue transglutaminase (tTG) for the diagnosis of pediatric celiac disease (CD). PATIENTS AND METHODS:: All consecutive patients <18 years tested for tTG and/or DGP and who underwent duodenal biopsy because of suspected CD in Stockholm and Gothenburg, Sweden, 2008-2010 were included. Medical records were reviewed. RESULTS:: Of 537 children who underwent duodenal biopsy, 278(52%) had CD. 71(13%) were <2 years and 13(4%) had IgA deficiency. Sensitivity and specificity for tTG was 94% and 86% respectively. Corresponding values for DGP was 91% and 26%. Positive predictive values (PPV) were 88% for tTG and 51% for DGP. There were 148 children who were tTG negative and DGP positive, of which only 5%(8/148) had villous atrophy. Among children <2 years with normal IgA, PPV was 96%(25/26) for tTG and 48%(24/50) for DGP. In 13 IgA deficient children 9 were DGP positive of which 4 had CD (PPV 44%). 8/278 cases of CD would possibly have been missed without DGP. The cost of adding DGP and consequently more biopsies to be able to detect 8 extra cases of CD was &OV0556;399,520 or &OV0556;49,940 per case. CONCLUSION:: For diagnosing CD, tTG is superior to DGP, even in children <2 years. Combining tTG and DGP does not provide a better trade off between number of missed cases of CD, number of unnecessary duodenal biopsies and cost than tTG alone.
Authors:
Ola Olen; Audur H Gudjónsdóttir; Lars Browaldh; Mozaffar Hessami; Kerstin Elvin; Ann-Sofie Liedberg; Martin Neovius; Lena Grahnquist
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-19
Journal Detail:
Title:  Journal of pediatric gastroenterology and nutrition     Volume:  -     ISSN:  1536-4801     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8211545     Medline TA:  J Pediatr Gastroenterol Nutr     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
*Sachs' Children's Hospital, Stockholm, Sweden †Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden ‡Department of Pediatrics, Queen Silvia Children's Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden §Astrid Lindgren Children's Hospital, Karolinska Institutet, Stockholm, Sweden ||Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden ¶Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden #Clinical Immunology and Transfusion Medicine, Labmedicin, Lund, Sweden.
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