Abstract
Background and Aims: Anti-tissue transglutaminase antibodies (anti-tTG) have simplified celiac disease (CD) diagnosis. However, in atypical forms of CD, intestinal biopsy sampling is still required. This prospective study investigates whether histologic analysis of the duodenal bulb combined with intestinal IgA anti-tTG deposit immunoassay makes CD diagnosis possible in at-risk children with low concentrations of serum anti-tTG. Methods: Histologic and intestinal IgA anti-tTG deposit immunoassays were used. Results: Two hundred forty-five symptomatic children positive for serum anti-tTG (>7 U/mL) were enrolled and divided into 3 groups: extensive duodenal atrophy (n = 209), with IgA anti-tTG deposits throughout the duodenum and high serum anti-tTG concentrations (157 ± 178 U/mL); bulb duodenal atrophy (n = 22), with widespread IgA anti-tTG deposits in 9 and in the bulb alone in 13 and low serum anti-tTG concentrations (13.9 ± 8.7 U/mL); and normal duodenum (n = 14), with widespread IgA anti-tTG deposits in 8 and in the bulb alone in 6 and low serum anti-tTG concentrations (10.6 ± 6.2 U/mL). All patients in the first 2 groups were diagnosed with CD and 8 from the third group. All improved after 1 year of gluten-free diet. Bulb duodenal analysis led to a 12% (30/245) increase in CD diagnosis. No CD-related lesions were observed in the 30 control subjects. Conclusions: In children at risk for CD, bulb duodenum biopsy sampling is essential to identify villous atrophy and detect IgA anti-tTG deposits even in absence of intestinal lesions. These mucosal autoantibodies could well represent a new standard for diagnosing CD.
| Original language | English |
|---|---|
| Pages (from-to) | 521-526 |
| Number of pages | 6 |
| Journal | Gastrointestinal Endoscopy |
| Volume | 88 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Sep 1 2018 |
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ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Gastroenterology
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Immunohistologic analysis of the duodenal bulb : a new method for celiac disease diagnosis in children. / De Leo, Luigina; Villanacci, Vincenzo; Ziberna, Fabiana; Vatta, Serena; Martelossi, Stefano; Di Leo, Grazia; Zanchi, Chiara; Bramuzzo, Matteo; Giudici, Fabiola; Ventura, Alessandro; Not, Tarcisio.
In: Gastrointestinal Endoscopy, Vol. 88, No. 3, 01.09.2018, p. 521-526.Research output: Contribution to journal › Article
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TY - JOUR
T1 - Immunohistologic analysis of the duodenal bulb
T2 - a new method for celiac disease diagnosis in children
AU - De Leo, Luigina
AU - Villanacci, Vincenzo
AU - Ziberna, Fabiana
AU - Vatta, Serena
AU - Martelossi, Stefano
AU - Di Leo, Grazia
AU - Zanchi, Chiara
AU - Bramuzzo, Matteo
AU - Giudici, Fabiola
AU - Ventura, Alessandro
AU - Not, Tarcisio
PY - 2018/9/1
Y1 - 2018/9/1
N2 - Background and Aims: Anti-tissue transglutaminase antibodies (anti-tTG) have simplified celiac disease (CD) diagnosis. However, in atypical forms of CD, intestinal biopsy sampling is still required. This prospective study investigates whether histologic analysis of the duodenal bulb combined with intestinal IgA anti-tTG deposit immunoassay makes CD diagnosis possible in at-risk children with low concentrations of serum anti-tTG. Methods: Histologic and intestinal IgA anti-tTG deposit immunoassays were used. Results: Two hundred forty-five symptomatic children positive for serum anti-tTG (>7 U/mL) were enrolled and divided into 3 groups: extensive duodenal atrophy (n = 209), with IgA anti-tTG deposits throughout the duodenum and high serum anti-tTG concentrations (157 ± 178 U/mL); bulb duodenal atrophy (n = 22), with widespread IgA anti-tTG deposits in 9 and in the bulb alone in 13 and low serum anti-tTG concentrations (13.9 ± 8.7 U/mL); and normal duodenum (n = 14), with widespread IgA anti-tTG deposits in 8 and in the bulb alone in 6 and low serum anti-tTG concentrations (10.6 ± 6.2 U/mL). All patients in the first 2 groups were diagnosed with CD and 8 from the third group. All improved after 1 year of gluten-free diet. Bulb duodenal analysis led to a 12% (30/245) increase in CD diagnosis. No CD-related lesions were observed in the 30 control subjects. Conclusions: In children at risk for CD, bulb duodenum biopsy sampling is essential to identify villous atrophy and detect IgA anti-tTG deposits even in absence of intestinal lesions. These mucosal autoantibodies could well represent a new standard for diagnosing CD.
AB - Background and Aims: Anti-tissue transglutaminase antibodies (anti-tTG) have simplified celiac disease (CD) diagnosis. However, in atypical forms of CD, intestinal biopsy sampling is still required. This prospective study investigates whether histologic analysis of the duodenal bulb combined with intestinal IgA anti-tTG deposit immunoassay makes CD diagnosis possible in at-risk children with low concentrations of serum anti-tTG. Methods: Histologic and intestinal IgA anti-tTG deposit immunoassays were used. Results: Two hundred forty-five symptomatic children positive for serum anti-tTG (>7 U/mL) were enrolled and divided into 3 groups: extensive duodenal atrophy (n = 209), with IgA anti-tTG deposits throughout the duodenum and high serum anti-tTG concentrations (157 ± 178 U/mL); bulb duodenal atrophy (n = 22), with widespread IgA anti-tTG deposits in 9 and in the bulb alone in 13 and low serum anti-tTG concentrations (13.9 ± 8.7 U/mL); and normal duodenum (n = 14), with widespread IgA anti-tTG deposits in 8 and in the bulb alone in 6 and low serum anti-tTG concentrations (10.6 ± 6.2 U/mL). All patients in the first 2 groups were diagnosed with CD and 8 from the third group. All improved after 1 year of gluten-free diet. Bulb duodenal analysis led to a 12% (30/245) increase in CD diagnosis. No CD-related lesions were observed in the 30 control subjects. Conclusions: In children at risk for CD, bulb duodenum biopsy sampling is essential to identify villous atrophy and detect IgA anti-tTG deposits even in absence of intestinal lesions. These mucosal autoantibodies could well represent a new standard for diagnosing CD.
UR - http://www.scopus.com/inward/record.url?scp=85050085130&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85050085130&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2018.05.014
DO - 10.1016/j.gie.2018.05.014
M3 - Article
C2 - 29807020
AN - SCOPUS:85050085130
VL - 88
SP - 521
EP - 526
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
SN - 0016-5107
IS - 3
ER -