May Antitransglutaminase Levels Predict Severity of Duodenal Lesions in Adults with Celiac Disease?

<i>Background and Objective</i>: Pediatric guidelines on celiac disease (CD) state that children with anti-transglutaminase antibodies (TGAs) >×10 upper limit of normal (ULN) may avoid endoscopy and biopsy. We aimed to evaluate whether these criteria may be suitable for villous atroph...

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Autores principales:	Giuseppe Losurdo, Milena Di Leo, Edoardo Santamato, Antonio Giangaspero, Maria Rendina, Carmelo Luigiano, Enzo Ierardi, Alfredo Di Leo
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	celiac disease serology villous atrophy anti-transglutaminase adults Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/42f70ef61b0f4b49b4560908650bb4ee
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spelling	oai:doaj.org-article:42f70ef61b0f4b49b4560908650bb4ee2021-11-25T18:18:37ZMay Antitransglutaminase Levels Predict Severity of Duodenal Lesions in Adults with Celiac Disease?10.3390/medicina571112121648-91441010-660Xhttps://doaj.org/article/42f70ef61b0f4b49b4560908650bb4ee2021-11-01T00:00:00Zhttps://www.mdpi.com/1648-9144/57/11/1212https://doaj.org/toc/1010-660Xhttps://doaj.org/toc/1648-9144<i>Background and Objective</i>: Pediatric guidelines on celiac disease (CD) state that children with anti-transglutaminase antibodies (TGAs) >×10 upper limit of normal (ULN) may avoid endoscopy and biopsy. We aimed to evaluate whether these criteria may be suitable for villous atrophy diagnosis in CD adults. <i>Materials and Methods</i>: We retrospectively enrolled patients with CD aged >18 years. TGAs were expressed as xULN. Duodenal lesions were classified as atrophic or non-atrophic according to Marsh-Oberhuber. Fisher’s exact and <i>t</i>-test were used for variables comparison. Receiver operating characteristics (ROC) curve analysis was performed with estimation of area under the curve (AUC), sensitivity, specificity, and positive and negative predictive value (PPV/NPV). <i>Results:</i> One hundred and twenty-one patients were recruited. Sixty patients (49.6%) had TGA >×10 ULN, and 93 (76.8%) had villous atrophy. The cut-off of >×10 ULN had sensitivity = 53.7%, specificity = 64.3%, PPV = 83.3%, and NPV = 29.5% to predict atrophy. Therefore, considering pediatric criteria, in 50 (41.3%) patients, biopsy could have been avoided. Patient subgroup with atrophy had higher TGA levels despite being not significant (37.2 ± 15.3 vs. 8.0 ± 1.3 ULN, <i>p</i> = 0.06). In adults, a slightly better diagnostic performance was obtained using a cut-off of TGA >×6.2 ULN (sensitivity = 57.1%, specificity = 65.6%, and AUC = 0.62). <i>Conclusions:</i> Despite our confirmation that villous atrophy is linked to high TGA levels, CD and atrophy diagnosis based only on serology is not reliable in adults.Giuseppe LosurdoMilena Di LeoEdoardo SantamatoAntonio GiangasperoMaria RendinaCarmelo LuigianoEnzo IerardiAlfredo Di LeoMDPI AGarticleceliac diseaseserologyvillous atrophyserologyanti-transglutaminaseadultsMedicine (General)R5-920ENMedicina, Vol 57, Iss 1212, p 1212 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	celiac disease serology villous atrophy serology anti-transglutaminase adults Medicine (General) R5-920
spellingShingle	celiac disease serology villous atrophy serology anti-transglutaminase adults Medicine (General) R5-920 Giuseppe Losurdo Milena Di Leo Edoardo Santamato Antonio Giangaspero Maria Rendina Carmelo Luigiano Enzo Ierardi Alfredo Di Leo May Antitransglutaminase Levels Predict Severity of Duodenal Lesions in Adults with Celiac Disease?
description	<i>Background and Objective</i>: Pediatric guidelines on celiac disease (CD) state that children with anti-transglutaminase antibodies (TGAs) >×10 upper limit of normal (ULN) may avoid endoscopy and biopsy. We aimed to evaluate whether these criteria may be suitable for villous atrophy diagnosis in CD adults. <i>Materials and Methods</i>: We retrospectively enrolled patients with CD aged >18 years. TGAs were expressed as xULN. Duodenal lesions were classified as atrophic or non-atrophic according to Marsh-Oberhuber. Fisher’s exact and <i>t</i>-test were used for variables comparison. Receiver operating characteristics (ROC) curve analysis was performed with estimation of area under the curve (AUC), sensitivity, specificity, and positive and negative predictive value (PPV/NPV). <i>Results:</i> One hundred and twenty-one patients were recruited. Sixty patients (49.6%) had TGA >×10 ULN, and 93 (76.8%) had villous atrophy. The cut-off of >×10 ULN had sensitivity = 53.7%, specificity = 64.3%, PPV = 83.3%, and NPV = 29.5% to predict atrophy. Therefore, considering pediatric criteria, in 50 (41.3%) patients, biopsy could have been avoided. Patient subgroup with atrophy had higher TGA levels despite being not significant (37.2 ± 15.3 vs. 8.0 ± 1.3 ULN, <i>p</i> = 0.06). In adults, a slightly better diagnostic performance was obtained using a cut-off of TGA >×6.2 ULN (sensitivity = 57.1%, specificity = 65.6%, and AUC = 0.62). <i>Conclusions:</i> Despite our confirmation that villous atrophy is linked to high TGA levels, CD and atrophy diagnosis based only on serology is not reliable in adults.
format	article
author	Giuseppe Losurdo Milena Di Leo Edoardo Santamato Antonio Giangaspero Maria Rendina Carmelo Luigiano Enzo Ierardi Alfredo Di Leo
author_facet	Giuseppe Losurdo Milena Di Leo Edoardo Santamato Antonio Giangaspero Maria Rendina Carmelo Luigiano Enzo Ierardi Alfredo Di Leo
author_sort	Giuseppe Losurdo
title	May Antitransglutaminase Levels Predict Severity of Duodenal Lesions in Adults with Celiac Disease?
title_short	May Antitransglutaminase Levels Predict Severity of Duodenal Lesions in Adults with Celiac Disease?
title_full	May Antitransglutaminase Levels Predict Severity of Duodenal Lesions in Adults with Celiac Disease?
title_fullStr	May Antitransglutaminase Levels Predict Severity of Duodenal Lesions in Adults with Celiac Disease?
title_full_unstemmed	May Antitransglutaminase Levels Predict Severity of Duodenal Lesions in Adults with Celiac Disease?
title_sort	may antitransglutaminase levels predict severity of duodenal lesions in adults with celiac disease?
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/42f70ef61b0f4b49b4560908650bb4ee
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May Antitransglutaminase Levels Predict Severity of Duodenal Lesions in Adults with Celiac Disease?

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