Follow-up of pediatric celiac disease: value of antibodies in predicting mucosal healing, a prospective cohort study

BMC Gastroenterology

Andreas Vécsei³  Wolfgang Huf⁴  Regine Schoenlechner²  Harald Vogelsang⁵  Andreas Chott¹  Gabriele Amann⁶  Oskar A Haas³  Karin Hammer³  Albina Innerhofer³  Hubert Kogler³  Stephanie Steinwendner³  Edith Vécsei³ 

[1]Institute of Pathology and Microbiology, Wilhelminenspital, Vienna, Austria

[2]Department of Food Science and Technology, Institute of Food Technology, University of Natural Resources and Life Sciences, Vienna, Austria

[3]Department of Pediatrics, Pediatric Gastroenterology, St. Anna Children's Hospital, Medical University Vienna, Kinderspitalgasse 6, 1090 Vienna, Austria

[4]Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria

[5]Department of Internal Medicine III, Division for Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria

[6]Clinical Department of Pathology, Medical University Vienna, Vienna, Austria

关键词: Specificity;    Sensitivity;    Endomysial antibodies;    Follow-up;    Celiac disease;    Pediatrics;   

Others  :  855716
DOI  :  10.1186/1471-230X-14-28

 received in 2014-01-30, accepted in 2014-02-03,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Vécsei et al.; licensee BioMed Central Ltd.

【 图 表 】

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