Elsevier

The Journal of Pediatrics

Volume 137, Issue 3, September 2000, Pages 356-360
The Journal of Pediatrics

Original Articles
Transglutaminase antibodies in children with a genetic risk for celiac disease,☆☆

https://doi.org/10.1067/mpd.2000.107582Get rights and content

Abstract

Objectives: The transglutaminase (TG) antibody test is accurate in identifying celiac disease in symptomatic children. We sought to determine the positive predictive value of this test in asymptomatic children at genetic risk for celiac disease. Study design: Asymptomatic children with a genetic risk for celiac disease were studied to investigate the relationships between TG antibody titer, small bowel histology, growth, and clinical features. Small bowel biopsy histology was graded by using the system of Marsh. Results: Of 30 children with a positive TG antibody test result, 21 (70%) had definite (Marsh score 2 or 3) and 4 (13%) had possible (Marsh score 1) biopsy evidence of celiac disease. TG antibody titer correlated with Marsh score (r = 0.569, P <.01). There was an inverse correlation between Marsh score and height z score (r = –0.361, P =.05). Conclusions: In this group of asymptomatic children screened because of a genetic risk, TG antibodies have a positive predictive value of 70% to 83% for biopsy evidence of celiac disease and may identify children before clinical features of celiac disease develop. (J Pediatr 2000;137:356-60)

Section snippets

Subjects

Subjects were participants in a large prospective study evaluating genetic and environmental factors that may contribute to development of autoimmunity, especially as related to type 1 diabetes.10 One arm of this study screens newborns for HLA types associated with type 1 diabetes and celiac disease. The newborns are stratified at birth according to risk group (HLA DR3/3, 3/4, 3/x as markers for DQ2) and are tested for TG antibodies at 9, 15, and 24 months, then yearly.10 In a separate study

RESULTS

Of 35 children with TG antibodies, 30 consented to enrollment. The mean age was 7.1 ± 3.9 years with a range of 2 to 16 years; 50% were male, and 83% of the subjects were non-Hispanic white (Table).

Table. Data on 30 children with a genetic risk for celiac disease and positive TG antibodies

Given genetic risk (%)
 Type 1 diabetes47
 First-degree relative*37
 At-risk HLA genotype on newborn screening16
Male (%)50
Age in years (range)7.1 (2.3-15.8)
Ethnic distribution (%)
 Non-Hispanic white83
 Hispanic7
 Other10

DISCUSSION

Asymptomatic children with a genetic risk for celiac disease, such as type 1 diabetes, are currently being screened for celiac disease.8, 19 The TG antibody assay is gradually replacing the endomysial and other antibody tests in such screening programs because of reproducibility, ease of performance, and cost. A strong concordance has been demonstrated between the endomysial antibody and TG antibody assays.12, 13, 14, 20 However, there is a paucity of published data assessing the predictive

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Supported by National Institutes of Health grant M01 RR00069, General Clinical Research Centers Program, National Center for Research Resources, and NIDDK R01-DK50979.

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Reprint requests: Edward J. Hoffenberg, MD, B-290, 1056 E 19th Ave, Denver, CO 80218.

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