Akademik Veri Yönetim Sistemi
2th Annual Meeting of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition, GLASKOV, İSKOÇYA, 5 - 08 Haziran 2019, cilt.68, sa.1, ss.86
Objectives and Study: The last ESPGHAN guideline for the diagnosis of coeliac disease (CD) states
that histological assessment may be omitted in symptomatic patients who have high IgA anti-tissue
transglutaminase (anti-tTG) levels (10 times above ULN), verified by EMA positivity, and are HLADQ2
and/or HLA-DQ8 heterodimer positive. The aim of this study was to assess the accuracy of serological
tests in diagnosis of CD in asymptomatic individuals, belonging to high-risk groups for CD.
Methods: From January 2013 to October 2018, endoscopy database was reviewed for the
asymptomatic patients who have a CD related risk factor and positive serum tTG IgA. Data including
anti-tTG titer and EMA, risk group, and histological findings were recorded. Patients having selective
IgA deficiency were excluded. Endoscopic biopsies evaluated according to the modified Marsh-
Oberhuber criteria were retrieved. The relationship between histological findings and concomitant antitTG
titers and EMA status was analysed.
Results: A total of 69 asymptomatic children who had a positive tTG serology and belonged to a
coeliac associated risk group were included in the study. The age of the patients ranged from 27
months to 17 years (median 10.5 years) and 56.5% of them were girls. The underlying risk factors
were: being first-degree relatives of CD (47.8%), type-1 diabetes mellitus (40.6%), Down syndrome
(7.2%), Turner syndrome (2.9%) and autoimmune thyroiditis (1.4%). Thirty-four out of 69 (49.3%)
asymptomatic children had anti-tTG levels >10 X ULN (N < 20 IU/mL). Forty-eight (69.6%) of the
patients were also positive for EMA antibody; the statistical data are shown in table 1. Fifty patients
(72.4%) had definite histological evidence (Marsh 3) for CD, whereas 7 (10.1%) and 12 (17.4%)
children had duodenal histopathology compatible with Marsh 1 and Marsh 0, respectively. Villous
atrophy was present in 30 (88.2%) of 34 children with anti-tTG >10 X ULN. Thirty-nine out of 48
(81.2%) children who had positive serology for both tests (tTG and EMA) got the coeliac diagnosis
after the endoscopy. There were 33 children who had both high titer of tTG and EMA, and 29 (87.8%)
of them had villous atrophy.
Conclusion: There are scarce studies arguing a “biopsy-sparing” protocol for both symptomatic and
asymptomatic patients with high serum anti-tTG titer. As distinct from the previous studies, we
concluded that high serum anti-tTG titer in asymptomatic children carrying a risk factor for developing
coeliac disease does not eliminate the need for intestinal biopsy. Furthermore, concomitant EMA
positivity did not add any positive effect in this group.