Evidence supporting safe diagnosis of coeliac disease in children with antitissue transglutaminase titre ≥5 times upper limit of normal.

Autor:	Paul SP; Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK siba.paul@nhs.net.; Paediatrics, Yeovil District Hospital, Yeovil, UK., Raja DI; Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK.; Medical School, University of Exeter, Exeter, Devon, UK., Sandhu BK; Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK., Rao SR; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK., Spray CH; Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK., Wiskin AE; Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK., Selvarajan L; Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK., Volonaki E; Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK., Ramani P; Paediatric Histopathology, Bristol Royal Hospital for Children, Bristol, UK., Tashtoush LB; Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK., Basude D; Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK.
Jazyk:	angličtina
Zdroj:	Archives of disease in childhood [Arch Dis Child] 2022 Aug; Vol. 107 (8), pp. 747-751. Date of Electronic Publication: 2022 Feb 16.
DOI:	10.1136/archdischild-2021-322000
Abstrakt:	Objective: European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines on coeliac disease (CD) recommend that children who have IgA-based antitissue transglutaminase (TGA-IgA) titre ≥10× upper limit of normal (ULN) and positive antiendomysial antibody, can be reliably diagnosed with CD via the no-biopsy pathway. The aim of this study was to examine the relationship between TGA-IgA ≥5×ULN and histologically confirmed diagnosis of CD. Methods: Data including TGA-IgA levels at upper gastrointestinal endoscopy and histological findings from children diagnosed with CD following endoscopy from 2006 to 2021 were analysed. CD was confirmed by Marsh-Oberhuber histological grading 2 to 3 c. Statistical analysis was performed using χ² analysis (p<0.05= significant). Results: 722 of 758 children had histological confirmation of CD. 457 children had TGA-IgA ≥5×ULN and 455 (99.5%) of these had histological confirmation for CD; the two that did not had eventual diagnosis of CD based on clinicopathological features. 114 of 457 had between TGA-IgA ≥5×ULN and <10×ULN, all had confirmed CD. The likelihood of a positive biopsy with TGA-IgA ≥5×ULN (455/457) compared with TGA-IgA <5×ULN (267/301) has strong statistical significance (p<0.00001). The optimal TGA-IgA cut-off from receiver operating characteristic curve analysis was determined to be below 5×ULN for the two assays used. Conclusion: 99.5% of children with TGA-IgA ≥5×ULN had histological confirmation of CD, suggesting that CD diagnosis can be made securely in children with TGA-IgA ≥5×ULN. If other studies confirm this finding, there is a case to be made to modify the ESPGHAN guidelines to a lower threshold of TGA-IgA for serological diagnosis of CD. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu