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Vecsei, E; Steinwendner, S; Kogler, H; Innerhofer, A; Hammer, K; Haas, OA; Amann, G; Chott, A; Vogelsang, H; Schoenlechner, R; Huf, W; Vecsei, A.
(2014): Follow-up of pediatric celiac disease: value of antibodies in predicting mucosal healing, a prospective cohort study
BMC GASTROENTEROL. 2014; 14: FullText FullText_BOKU

Background: In diagnosing celiac disease (CD), serological tests are highly valuable. However, their role in following up children with CD after prescription of a gluten-free diet is unclear. This study aimed to compare the performance of antibody tests in predicting small-intestinal mucosal status in diagnosis vs. follow-up of pediatric CD. Methods: We conducted a prospective cohort study at a tertiary-care center. 148 children underwent esophohagogastroduodenoscopy with biopsies either for symptoms +/- positive CD antibodies (group A; n = 95) or following up CD diagnosed >= 1 year before study enrollment (group B; n = 53). Using biopsy (Marsh >= 2) as the criterion standard, areas under ROC curves (AUCs) and likelihood-ratios were calculated to estimate the performance of antibody tests against tissue transglutaminase (TG2), deamidated gliadin peptide (DGP) and endomysium (EMA). Results: AUCs were higher when tests were used for CD diagnosis vs. follow-up: 1 vs. 0.86 (P = 0.100) for TG2-IgA, 0.85 vs. 0.74 (P = 0.421) for TG2-IgG, 0.97 vs. 0.61 (P = 0.004) for DPG-IgA, and 0.99 vs. 0.88 (P = 0.053) for DPG-IgG, respectively. Empirical power was 85% for the DPG-IgA comparison, and on average 33% (range 13-43) for the non-significant comparisons. Among group B children, 88.7% showed mucosal healing (median 2.2 years after primary diagnosis). Only the negative likelihood-ratio of EMA was low enough (0.097) to effectively rule out persistent mucosal injury. However, out of 12 EMA-positive children with mucosal healing, 9 subsequently turned EMA-negative. Conclusions: Among the CD antibodies examined, negative EMA most reliably predict mucosal healing. In general, however, antibody tests, especially DPG-IgA, are of limited value in predicting the mucosal status in the early years post-diagnosis but may be sufficient after a longer period of time.
Authors BOKU Wien:
Schönlechner Regine
Find related publications in this database (using NML MeSH Indexing)
Adolescent;Biopsy;Celiac Disease/blood*;Celiac Disease/diet therapy;Celiac Disease/pathology;Child;Child, Preschool;Cross-Sectional Studies;Diet, Gluten-Free;Endoscopy, Gastrointestinal;Female;Follow-Up Studies;GTP-Binding Proteins;Gliadin/immunology*;Humans;Immunoglobulin A/blood*;Immunoglobulin G/blood*;Intestinal Mucosa/pathology;Intestine, Small/pathology*;Male;Peptide Fragments/immunology;Prospective Studies;Sensitivity and Specificity;Transglutaminases/immunology*;Wound Healing;Young Adult;

Find related publications in this database (Keywords)
Celiac disease
Endomysial antibodies

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