Border-line coeliac serology in children – Outcome and correlation with histology (2017)

Type of publication:
Conference abstract

*Fox H.; Cheng J.H.; *Singh R.; *Ayub N.

Journal of Pediatric Gastroenterology and Nutrition; Apr 2017; vol. 64 ; Supplement 1, p. 18

Objectives and study: Coeliac disease is an immune-mediated condition that affects the lining of the intestine when exposed to gluten. The British Society of Paediatric Gastroenterology, Hepatology and Nutrition guideline on Coeliac Disease (2013) recommends that patients with Tissue Transglutaminase antibodies (TTG) less than 10 times normal should undergo duodenal biopsy to confirm a diagnosis of Coeliac Disease. However, there is a paucity of data on how often this correlates with a final diagnosis of Coeliac disease. This study is to measure the sensitivity of borderline Tissue Transglutaminase Antibody (TTG) levels (greater than normal but less than 10 times of normal values) in diagnosing Coeliac disease. Methods: The Study Population was children aged 1-16 years with TTG levels less than 10 times of normal seen at The Shrewsbury & Telford Hospitals NHS Trust. The study period was from January 2010 to September 2016. Patients were identified from the biochemistry database. Relevant data including the clinical symptoms, TTG levels, IgA levels, HLA status and histology results were collected using the hospital data base. The histology results were classified according to the Modified Marsh Criteria. Results: A total of 52 patients had TTG levels between 2 – 19.9 U/ml which is less than ten times of the normal range used by our biochemistry laboratory. The median age of presentation was 10 years while the median TTG value was 4.2U/ml. 10 patients with Type 1 Diabetes Mellitus were detected to have border-line positive coeliac serology on routine testing. Thirty-nine patients underwent endoscopy with duodenal biopsies. Ten patients had neither endoscopy nor HLA testing performed because of various reasons including parental choice, symptom resolution prior to endoscopy while still on a normal diet, or repeat TTG levels within the normal range. 29 children (56%) out of the cohort of 52 had histological changes consistent with coeliac disease and were diagnosed as such. Seven of these (24%) had Grade 1 Marsh criteria, 3 children (10%) had Grade 2 Marsh criteria and 19 (66%) had Grade 3 Marsh criteria. There was no significant difference in symptomatology between the children who were diagnosed with coeliac disease and those with normal biopsies, apart from recurrent abdominal pain which was commoner in coeliac disease. Conclusion: 56% of children with borderline TTG levels were diagnosed with coeliac disease based on biopsy changes. Symptomatology was of poor discriminatory value apart from recurrent abdominal pain which was commoner in coeliac disease. Children with border-line positive coeliac serology should have duodenal biopsies to confirm a diagnosis of coeliac disease.

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