Diagnostic Accuracy of IgA anti-Tissue Transglutaminase in Celiac Disease in Van-Turkey

Abstract

Background and aim: Although the IgA anti-tissue transglutaminase test (IgA anti-tTG) has been recommended as the first step in the diagnosis of celiac disease (CD), there are controversial data about the real accuracy of the test in clinical practice. Therefore we evaluated the sensitivity and specificity of the IgA anti-tTG in a group of patients who were suspected of having CD.

Material and methods: The study was performed at Van Training and Research Hospital, Van-Turkey. Details of patients in whom the IgA anti-tTG was requested from January 2009 to April 2012 were obtained from databases. Duplicate requests were excluded. Histopathologic examination of duodenal biopsies and serologic evaluations were compared.

Results: A total of 1614 IgA anti-tTG were requested from different patients. In all, 49.6%  of requests were in females and 29.8% from children under the age of sixteen. A total of 192 (11.9%) requests were found to be positive. Duodenal biopsies were performed to 61 (31.8%) of seropositive patients. The overall sensitivity and specificity of IgA anti-tTG were 93.3% and 9.5%.

Conclusion: Our data have revealed that clinicians should be aware of solely relying on the results of the IgA anti-tTG test could result in unnecessary diagnostic procedures and treatments.

Key words: Celiac disease, sensitivity, serologic tests, specifity, tissue transglutaminase

Keywords

• Celiac disease, sensitivity, serologic tests, specificity, tissue transglutaminase

References

1. Volta U, Fabbri A, Parisi C, et al. Old and new serological tests for celiac disease screening. Expert Rev Gastroenterol Hepatol 2010; 4: 31-35.
2. Lewis NR, Scott BB. Meta-analysis: deamidated gliadin peptide antibody and tissue transglutaminase antibody compared as screening tests for coeliac disease. Aliment Pharmacol Ther 2010; 31: 73-81.
3. Rashtak S, Ettore MW, Homburger HA, Murray JA. Combination testing for antibodies in the diagnosis of coeliac disease: comparison of multiplex immunoassay and ELISA methods. Aliment Pharmacol Ther 2008; 28: 805-813.
4. Rostom A, Murray JA, Kagnoff MF. American Gastroenterological Association (AGA) Institute technical review on the diagnosis and management of celiac disease. Gastroenterology 2006; 131: 1981- 2002.
5. Abrams JA, Brar P, Diamond B, Rotterdam H, Green PH. Utility in clinical practice of immunoglobulin a anti-tissue transglutaminase antibody for the diagnosis of celiac disease. Clin Gastroenterol Hepatol 2006; 4: 726-730.
6. Rostami K, Kerckhaert J, Tiemessen R, et al. Sensitivity of antiendomysium and antigliadin antibodies in untreated celiac disease: disappointing in clinical practice. Am J Gastroenterol 1999; 94: 888- 894.
7. Dickey W, McMillan SA, Hughes DF. Sensitivity of serum tissue transglutaminase antibodies for endomysial antibody positive and negative coeliac disease. Scand J Gastroenterol 2001; 36: 511-514.
8. Dickey W, Hughes DF, McMillan SA. Reliance on serum endomysial antibody testing underestimates the true prevalence of coeliac disease by one fifth. Scand J Gastroenterol 2000; 35: 181-183.

9. Abrams JA, Diamond B, Rotterdam H, Green PH. Seronegative celiac disease: increased prevalence with lesser degrees of villous atrophy. Dig Dis Sci 2004; 49: 546-550.
10. Emami MH, Karimi S, Kouhestani S, Hashemi M, Taheri H. Diagnostic accuracy of IgA anti-tissue transglutaminase in patients suspected of having coeliac disease in Iran. J Gastrointestin Liver Dis. 2008; 17: 141-146.
11. Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol 1999; 11: 1185-1194.
12. Report of a working group of the united European gastroenterology week in Amsterdam: When is a coeliac a coeliac? Eur J Gastroenterol Hepatol 2001, 13: 1123-1128.
13. Hill ID, Dirks MH, Liptak GD, et al. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2005; 40: 1-19.
14. Bürgin-Wolff A, Mauro B, Faruk H. Intestinal biopsy is not always required to diagnose celiac disease: a retrospective analysis of combined antibody tests. BMC Gastroenterol 2013; 23: 13-19.
15. Geboes K, Geboes KP. Diagnosis and treatment of coeliac disease. F1000 Med Rep 2009; 1: 32.
16. Hummel S, Hummel M, Banholzer J, et al. Development of autoimmunity to transglutaminase C in children of patients with type 1 diabetes: relationship to islet autoantibodies and infant feeding. Diabetologia 2007; 50: 390-394.
17. Santaolalla R, Fernández-Bañares F, Rodríguez R, et al. Diagnostic value of duodenal antitissue transglutaminase antibodies in gluten-sensitive enteropathy. Aliment Pharmacol Ther 2008; 27: 820- 829.
18. McGowan KE, Lyon ME, Loken SD, Butzner JD. Celiac disease: are endomysial antibody test results being used appropriately? Clin Chem 2007; 53: 1775- 1781.
19. Pearce AB, Sinclair D, Duncan HD, Saas M, Poller DN. Use of the anti-endomysial antibody test to diagnose celiac disease in clinical practice. Clin Lab 2002; 48: 319-325.