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Evaluation of Celiac Disease by Minimally Invasive Biomarkers in a Spanish Pediatric Population
Julia María Cabo Del Riego1,2, María Jesús Núñez Iglesias3,4, Carmen García-Plata González5
1Clinical Analysis Laboratory, Department of Inmunology, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain.
Insights
Highly sensitive celiac disease (CD) biomarkers, including IgA-TG2 and IgA-EMA, simplify diagnosis. Strict application of IgA-TG2 levels and gluten-free diet response can reliably diagnose CD, reducing the need for biopsies.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Clinical Diagnostics
Background:
- Celiac disease (CD) diagnosis has improved with sensitive biomarkers like IgA-TG2, Ig-GDP, and IgA-EMA.
- European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines (2012, 2020) aim to simplify CD diagnosis and reduce biopsies.
Purpose of the Study:
- Evaluate the utility of CD-specific biomarkers.
- Assess the relationship between IgA-TG2 and IgA-EMA antibody titers.
Main Methods:
- Prospective study of 5641 pediatric patients (ages 0-16) from 2012-2019.
- Diagnosis followed the ESPGHAN algorithm.
- Analysis of serological tests and, where necessary, intestinal biopsies.
Main Results:
- 113 CD cases confirmed; 95 (84.1%) diagnosed serologically.
- Only 18 (15.9%) patients required intestinal biopsy.
- 100% concordance between IgA-EMA and IgA-TG2 ≥ 10 ULN (with IgA-EMA ≥ 1:80).
Conclusions:
- Positive correlation observed between IgA-TG2 and IgA-EMA antibody levels.
- Strict application of IgA-TG2 ≥ 10 ULN, confirmed by gluten-free diet response, can reliably diagnose CD.
Background:
The diagnosis of celiac disease (CD) has been substantially improved with the availability of highly sensitive CD-specific IgA-TG2, Ig-GDP, and IgA-EMA. The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) published (2012) and updated (2020) diagnostic criteria for CD in order to simplify CD diagnosis and to avoid biopsies in selected patients.
Methods:
A prospective study including 5641 pediatric patients (0-16 years old) from January 2012 to January 2019 was performed. CD diagnosis was made according to the ESPGHAN algorithm. The objective of this study was to evaluate the utility of biomarkers and the relationship between TGA-IgA and EMA titers.
Results:
CD diagnoses were confirmed in 113 patients, 110 were IgA-TG2-positive and 3 (2.7%) had IgA deficiency. The diagnosis was made by serologic tests in 95 (84.1%) patients. Only 18 (15.9%) patients underwent intestinal biopsy. We obtained 100% concordance between IgA-EMA and positive results for IgA-TG2 ≥ 10 ULN with IgA-EMA antibody titer ≥ 1:80.
Conclusions:
This study provides evidence of a positive correlation between IgA-TG2 antibody serum levels and IgA-EMA. The diagnosis could be guaranteed with strict application of IgA-TG2 values ≥ 10 ULN (confirmed by subsequent testing) plus the serological response to the gluten-free diet (GFD).
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