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

BMC Gastroenterology

Research Article

Wolfgang Huf¹  Gabriele Amann²  Regine Schoenlechner³  Harald Vogelsang⁴  Hubert Kogler⁵  Stephanie Steinwendner⁵  Oskar A Haas⁵  Andreas Vécsei⁵  Edith Vécsei⁵  Albina Innerhofer⁵  Karin Hammer⁵  Andreas Chott⁶ 

[1] Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria;Clinical Department of Pathology, Medical University Vienna, Vienna, Austria;Department of Food Science and Technology, Institute of Food Technology, University of Natural Resources and Life Sciences, Vienna, Austria;Department of Internal Medicine III, Division for Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria;Department of Pediatrics, Pediatric Gastroenterology, St. Anna Children's Hospital, Medical University Vienna, Kinderspitalgasse 6, 1090, Vienna, Austria;Institute of Pathology and Microbiology, Wilhelminenspital, Vienna, Austria;

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

DOI  :  10.1186/1471-230X-14-28

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

来源: Springer

【 摘 要 】

BackgroundIn 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.MethodsWe 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).ResultsAUCs 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.ConclusionsAmong 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】

CC BY   
© Vécsei et al.; licensee BioMed Central Ltd. 2014