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

Background and Objective: 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 a...

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Autores principales: Losurdo, Giuseppe, Di Leo, Milena, Santamato, Edoardo, Giangaspero, Antonio, Rendina, Maria, Luigiano, Carmelo, Ierardi, Enzo, Di Leo, Alfredo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8622174/
https://www.ncbi.nlm.nih.gov/pubmed/34833430
http://dx.doi.org/10.3390/medicina57111212
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author Losurdo, Giuseppe
Di Leo, Milena
Santamato, Edoardo
Giangaspero, Antonio
Rendina, Maria
Luigiano, Carmelo
Ierardi, Enzo
Di Leo, Alfredo
author_facet Losurdo, Giuseppe
Di Leo, Milena
Santamato, Edoardo
Giangaspero, Antonio
Rendina, Maria
Luigiano, Carmelo
Ierardi, Enzo
Di Leo, Alfredo
author_sort Losurdo, Giuseppe
collection PubMed
description Background and Objective: 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. Materials and Methods: 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 t-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). Results: 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, p = 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). Conclusions: 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.
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spelling pubmed-86221742021-11-27 May Antitransglutaminase Levels Predict Severity of Duodenal Lesions in Adults with Celiac Disease? Losurdo, Giuseppe Di Leo, Milena Santamato, Edoardo Giangaspero, Antonio Rendina, Maria Luigiano, Carmelo Ierardi, Enzo Di Leo, Alfredo Medicina (Kaunas) Article Background and Objective: 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. Materials and Methods: 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 t-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). Results: 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, p = 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). Conclusions: 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. MDPI 2021-11-05 /pmc/articles/PMC8622174/ /pubmed/34833430 http://dx.doi.org/10.3390/medicina57111212 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Losurdo, Giuseppe
Di Leo, Milena
Santamato, Edoardo
Giangaspero, Antonio
Rendina, Maria
Luigiano, Carmelo
Ierardi, Enzo
Di Leo, Alfredo
May Antitransglutaminase Levels Predict Severity of Duodenal Lesions in Adults with Celiac Disease?
title 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_short 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?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8622174/
https://www.ncbi.nlm.nih.gov/pubmed/34833430
http://dx.doi.org/10.3390/medicina57111212
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