Celiac Disease: The New Proposed ESPGHAN Diagnostic Criteria Do Work Well in a Selected Population

被引:57
作者
Klapp, Gabriela [1 ]
Masip, Etna [1 ]
Bolonio, Miguel [2 ]
Donat, Ester [1 ]
Polo, Begona [1 ]
Ramos, David [3 ]
Ribes-Koninckx, Carmen [1 ]
机构
[1] La Fe Univ Hosp, Valencia 46026, Spain
[2] La Fe Univ Hosp, Pediat Gastroenterol & Hepatol Invest Lab, Valencia 46026, Spain
[3] La Fe Univ Hosp, Dept Pathol, Valencia 46026, Spain
关键词
celiac disease; criteria; diagnosis; ANTITISSUE TRANSGLUTAMINASE ANTIBODIES; PATCHY VILLOUS ATROPHY; TISSUE TRANSGLUTAMINASE; PEDIATRIC-GASTROENTEROLOGY; ANTIGLIADIN ANTIBODIES; CHILDREN YOUNGER; IMMUNOGLOBULIN-A; BIOPSY; PREVALENCE; HEPATOLOGY;
D O I
10.1097/MPG.0b013e318279887b
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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.
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页码:251 / 256
页数:6
相关论文
共 50 条
[11]   Correlation of duodenal histology with tissue transglutaminase and endomysial antibody levels in pediatric celiac disease [J].
Donaldson, Matthew R. ;
Firth, Sean D. ;
Wimpee, Holly ;
Leiferman, Kristin M. ;
Zone, John J. ;
Horsley, Wyatt ;
O'Gorman, Molly A. ;
Jackson, W. Daniel ;
Neuhausen, Susan L. ;
Hull, Christopher M. ;
Book, Linda S. .
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, 2007, 5 (05) :567-573
[12]   Allelic distribution and the effect of haplotype combination for HLA type II loci in the celiac disease population of the Valencian community (Spain) [J].
Donat, E. ;
Planelles, D. ;
Capilla-Villanueva, A. ;
Montoro, J. A. ;
Palau, F. ;
Ribes-Koninckx, C. .
TISSUE ANTIGENS, 2009, 73 (03) :255-261
[13]   Anti-transglutaminase antibodies in non-coeliac children suffering from infectious diseases [J].
Ferrara, F. ;
Quaglia, S. ;
Caputo, I. ;
Esposito, C. ;
Lepretti, M. ;
Pastore, S. ;
Giorgi, R. ;
Martelossi, S. ;
Dal Molin, G. ;
Di Toro, N. ;
Ventura, A. ;
Not, T. .
CLINICAL AND EXPERIMENTAL IMMUNOLOGY, 2010, 159 (02) :217-223
[14]   Strongly positive tissue transglutaminase antibody assays without celiac disease [J].
Freeman, HJ .
CANADIAN JOURNAL OF GASTROENTEROLOGY, 2004, 18 (01) :25-28
[15]   Accuracy of Diagnostic Antibody Tests for Coeliac Disease in Children: Summary of an Evidence Report [J].
Giersiepen, Klaus ;
Lelgemann, Monika ;
Stuhldreher, Nina ;
Ronfani, Luca ;
Husby, Steffen ;
Koletzko, Sibylle ;
Korponay-Szabo, Ilma R. .
JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, 2012, 54 (02) :229-241
[16]  
Grodzinsky E, 1995, ACTA PAEDIATR, V84, P1
[17]   DIAGNOSIS OF CELIAC-DISEASE - TIME FOR A CHANGE [J].
GUANDALINI, S ;
VENTURA, A ;
ANSALDI, N ;
GIUNTA, AM ;
GRECO, L ;
LAZZARI, R ;
MASTELLA, G ;
RUBINO, A .
ARCHIVES OF DISEASE IN CHILDHOOD, 1989, 64 (09) :1320-1324
[18]   What are the sensitivity and specificity of serologic celiac disease? Do sensitivity and specificity vary in populations? [J].
Hill, ID .
GASTROENTEROLOGY, 2005, 128 (04) :S25-S32
[19]   Guideline for the diagnosis and treatment of celiac disease in children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition [J].
Hill, ID ;
Dirks, MH ;
Liptak, GS ;
Colletti, RB ;
Fasano, A ;
Guandalini, S ;
Hoffenberg, EJ ;
Horvath, K ;
Murray, JA ;
Pivor, M ;
Seidman, EG .
JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, 2005, 40 (01) :1-19
[20]   Coeliac disease: a biopsy is not always necessary for diagnosis [J].
Hill, P. G. ;
Holmes, G. K. T. .
ALIMENTARY PHARMACOLOGY & THERAPEUTICS, 2008, 27 (07) :572-577