Document Detail

Celiac disease: the new proposed ESPGHAN diagnostic criteria do work well in a selected population.
MedLine Citation:
PMID:  23111763     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The need for an early and accurate diagnosis in celiac disease (CD) has focused attention on new diagnostic approaches, based on the efficiency of serological markers and the high negative predictive value of human leukocyte antigen (HLA) non-DQ2/8.
METHODS: We performed a retrospective review of all of the patients suspected of having CD who had undergone a small bowel biopsy in our gastroenterology unit. All symptomatic children with serological marker at time of biopsy (immunoglobulin A-tissue transglutaminase antibody, endomysial antibody, and HLA genotype) were included. The triple test (TT) was positive if immunoglobulin A-tissue transglutaminase antibody was 10 times the upper limit of normal, plus positive endomysial antibody plus human leukocyte antigen-DQ2/DQ8.
RESULTS: A total of 150 patients met the inclusion criteria and were enrolled in the study. One hundred sixteen were positive for the TT; 113 of 116 (97.4%) had a Marsh 2/3 histological lesion and had been considered to have CD. Thus, positive predictive value of the TT was 97.4%. The other 3 cases (2.6%) had Marsh 0/1 lesion, so we consider them to be false-positives for the TT; however, on follow-up, all 3 children developed histological damage after a gluten challenge. Finally, the positive predictive value of the TT was 100%. Thirty-four patients were negative for the TT: 22 patients are celiac, 3 are celiac but challenge gluten diet is pending, and the 9 patients left have other gastrointestinal disorder.
CONCLUSIONS: Our study supports the view that in selected children who are symptomatic and positive for the TT, CD diagnosis could be established independent of histological findings.
Gabriela Klapp; Etna Masip; Miguel Bolonio; Ester Donat; Begoña Polo; David Ramos; Carmen Ribes-Koninckx
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Journal of pediatric gastroenterology and nutrition     Volume:  56     ISSN:  1536-4801     ISO Abbreviation:  J. Pediatr. Gastroenterol. Nutr.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-26     Completed Date:  2013-08-27     Revised Date:  2013-11-08    
Medline Journal Info:
Nlm Unique ID:  8211545     Medline TA:  J Pediatr Gastroenterol Nutr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  251-6     Citation Subset:  IM    
Pediatric Gastroenterology and Hepatology, La Fe University Hospital, Valencia, Spain.
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MeSH Terms
Autoantibodies / analysis*
Biological Markers / blood
Celiac Disease / blood,  diagnosis*,  immunology,  pathology
Child, Preschool
Follow-Up Studies
GTP-Binding Proteins / antagonists & inhibitors*
HLA Antigens / analysis,  genetics*
Immunoglobulin A / analysis
Intestinal Mucosa / pathology
Muscle Fibers, Skeletal / immunology*
Practice Guidelines as Topic*
Predictive Value of Tests
Retrospective Studies
Societies, Scientific
Transglutaminases / antagonists & inhibitors*
Reg. No./Substance:
0/Autoantibodies; 0/Biological Markers; 0/HLA Antigens; 0/Immunoglobulin A; EC 2.3.2.-/transglutaminase 2; EC; EC 3.6.1.-/GTP-Binding Proteins
Comment In:
J Pediatr Gastroenterol Nutr. 2013 Mar;56(3):241   [PMID:  23085890 ]

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