Raising the Cut-Off Level of Anti-Tissue Transglutaminase Antibodies to Detect Celiac Disease Reduces the Number of Small Bowel Biopsies in Children with Type 1 Diabetes: A Retrospective Study

Autor: Gera Hoorweg-Nijman, Petra van Setten, Anouk Velthuis, Ineke de Kruijff, Margreet Wessels, Eline Duijndam, Dick Mul, Ellen G van Lochem, Jan Alle Bokma, Janiëlle A E M van Alfen-van der Velden, Jos W. R. Meijer, M. Luisa Mearin, Eveline Berghout, Lian Roovers, Victorien M. Wolters
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
Adolescent
Tissue transglutaminase
Biopsy
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16]
Disease
Unnecessary Procedures
Sensitivity and Specificity
Gastroenterology
Antibodies
03 medical and health sciences
All institutes and research themes of the Radboud University Medical Center
0302 clinical medicine
GTP-Binding Proteins
030225 pediatrics
Internal medicine
Intestine
Small

medicine
Humans
Protein Glutamine gamma Glutamyltransferase 2
030212 general & internal medicine
Child
Pediatric gastroenterology
Retrospective Studies
Type 1 diabetes
Transglutaminases
biology
Receiver operating characteristic
business.industry
Retrospective cohort study
Hepatology
medicine.disease
Celiac Disease
Diabetes Mellitus
Type 1

ROC Curve
Child
Preschool

Pediatrics
Perinatology and Child Health

biology.protein
Female
Antibody
business
Zdroj: Journal of Pediatrics, 223, 87-+. MOSBY-ELSEVIER
Journal of Pediatrics, 223, pp. 87-92.e1
Journal of Pediatrics, 223, 87-92.e1
ISSN: 0022-3476
DOI: 10.1016/j.jpeds.2020.02.086
Popis: Objective To study the optimal cut-off value for anti-tissue transglutaminase type 2 IgA antibodies (TG2A) in serum to select for diagnostic small bowel biopsies for celiac disease in children with type 1 diabetes mellitus. Study design Children with type 1 diabetes mellitus with elevated TG2A titers and duodenal biopsies performed during the course of their diabetes treatment were included. Anti-endomysial antibodies were recorded if present. The optimal TG2A cut-off value, expressed as the ratio between obtained value and upper limit of normal (ULN), was determined using receiver operating characteristic curve analysis and compared with the cut-off value used in the European Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines in terms of sensitivity, specificity, positive and negative predictive value. Results We included 63 children. The optimal cut-off value for performing biopsies is demonstrated to be 11 times the ULN. Raising the cut-off value from 3 times the ULN to 11 times the ULN changed sensitivity from 96% to 87% and increased specificity from 36% to 73%, increased the positive predictive value from 88% to 94% and lowered negative predictive value from 67% to 53%. The percentage of normal histology was decreased from 12% to 6%. Conclusions Increasing the TG2A cut-off value for performing duodenal biopsies in children with type 1 diabetes mellitus and suspected celiac disease leads to a substantial reduction of unnecessary biopsies. We advocate to adapt the European Society for Pediatric Gastroenterology, Hepatology and Nutrition 2012 guidelines for this group of children, including monitoring patients with TG2A levels of less than 11 times the ULN over time.
Databáze: OpenAIRE