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Can High Titres of Anti Tissue Transglutaminase Antibodies Reduce the Need for Intestinal Biopsy for Diagnosis of Celiac Disease?

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Abstract

Traditionally small intestinal biopsy has been considered a gold standard for the diagnosis of celiac disease (CD). But now data has shown that serological markers like anti-tissue-transglutaminase antibodies (tTGA) can be used to make the diagnosis with great sensitivity and specificity. The objective of the present study was to evaluate whether patients with high probability of CD and high titre of tTGA, have a high probability of intestinal damage and may not require biopsy for final diagnosis. All the cases with tTGA levels ≥15 IU/ml and who subsequently underwent biopsy from July 2010 to June 2013 were selected. Histopathological findings graded as per Marsh classification were correlated with serum tTGA levels. Grade 3 lesions were considered diagnostic for the disease. Out of total 731 patients 470 had serum tTGA levels >100 IU/ml and 261 patients had <100 IU/ml. Highest levels of tTGA (219.3 IU/ml) were seen in grade 3c which was >12 times the normal cutoff value. Mean serum tTGA in higher histological grade i.e. 3 (3a, 3b, 3c) was 186.7 IU/ml (>12 times the normal cut off value) as compared to grade 1 which was 108.9 IU/ml (>7 times the normal cut off value). Using a tTGA cutoff value of 70 IU/ml, sensitivity was found to be 83.9% while specificity was 56.10% with an overall accuracy of 77.7%. This study confirms that a small intestinal biopsy is not always necessary for the diagnosis of CD in symptomatic patients with high tTGA levels (>70 IU/ml).

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References

  1. Kagnoff MF. Overview and pathogenesis of celiac disease. Gastroenterology. 2005;128:S10–8.

    Article  CAS  Google Scholar 

  2. Fasano A. Clinical presentation of celiac disease in the pediatric population. Gastroenterology. 2005;128:S68–73.

    Article  Google Scholar 

  3. Dewar DH, Ciclitira PJ. Clinical features and diagnosis of celiac disease. Gastroenterology. 2005;128:S19–24.

    Article  Google Scholar 

  4. Green PH, Jabri B. Celiac disease. Annu Rev Med. 2006;57:207–21.

    Article  CAS  Google Scholar 

  5. Catassi C, Bearzi I, Holmes GK. Association of celiac disease and intestinal lymphomas and other cancers. Gastroenterology. 2005;128:S79–86.

    Article  Google Scholar 

  6. Pink IJ, Creamer B. Response to a gluten-free diet of patients with the coeliac syndrome. Lancet. 1967;1:300–4.

    Article  CAS  Google Scholar 

  7. Paulley JW. Observation on the aetiology of idiopathic steatorrhoea; jejunal and lymph-node biopsies. Br Med J. 1954;2:1318–21.

    Article  CAS  Google Scholar 

  8. Mubarak A, Nikkels P, Houwen R, Ten Kate F. Reproducibility of the histological diagnosis of celiac disease. Scand J Gastroenterol. 2011;46:1065–73.

    Article  Google Scholar 

  9. Ravelli A, Villanacci V, Monfredini C, Martinazzi S, Grassi V, Manenti S. How patchy is patchy villous atrophy? Distribution pattern of histological lesions in the duodenum of children with celiac disease. Am J Gastroenterol. 2010;105:2103–10.

    Article  Google Scholar 

  10. Pais WP, Duerksen DR, Pettigrew NM, Bernstein CN. How many duodenal biopsy specimens are required to make a diagnosis of celiac disease? Gastrointest Endosc. 2008;67:1082–7.

    Article  Google Scholar 

  11. Hill PG, Forsyth JM, Semeraro D, Holmes GK. IgA antibodies to human tissue transglutaminase: audit of routine practice confirms high diagnostic accuracy. Scand J Gastroenterol. 2004;39:1078–82.

    Article  CAS  Google Scholar 

  12. Hopper AD, Hadjivassiliou M, Hurlstone DP, Lobo AJ, McAlindon ME, Egner W, et al. What is the role of serologic testing in celiac disease? A prospective, biopsy-confirmed study with economic analysis. Clin Gastroenterol Hepatol. 2008;6:314–20.

    Article  Google Scholar 

  13. Hadithi M, von Blomberg BM, Crusius JB, Bloemena E, Kostense PJ, Meijer JW, et al. Accuracy of serologic tests and HLA-DQ typing for diagnosing celiac disease. Ann Intern Med. 2007;147:294–302.

    Article  Google Scholar 

  14. Reeves GE, Squance ML, Duggan AE, Murugasu RR, Wilson RJ, Wong RC, et al. Diagnostic accuracy of coeliac serological tests: a prospective study. Eur J Gastroenterol Hepatol. 2006;18:493–501.

    Article  Google Scholar 

  15. Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, et al. European society for pediatric gastroenterology, hepatology, and nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr. 2012;54:136–60.

    Article  CAS  Google Scholar 

  16. Marsh MN. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’). Gastroenterology. 1992;102:330–54.

    Article  CAS  Google Scholar 

  17. Oberhuber G. Histopathology of celiac disease. Biomed Pharmacother. 2000;54:368–72.

    Article  CAS  Google Scholar 

  18. Dickson BC, Streutker CJ, Chetty R. Coeliac disease: an update for pathologists. Rev J Clin Pathol. 2006;59:1008–16.

    Article  CAS  Google Scholar 

  19. Kaukinen K, Maki M, Partanen J, Sievanen H, Collin P. Celiac disease without villous atrophy. Revision of criteria called for. Dig Dis Sci. 2001;46:879–87.

    Article  CAS  Google Scholar 

  20. Collin P, Kaukinen K, Vogelsang H, et al. Antiendomysial and antihuman recombinant tissue transglutaminase antibodies in diagnosis of celiac disease: a biopsy proven Europeon multicenter study. Eur J Gastroenterol Hepatol. 2005;17:85–91.

    Article  CAS  Google Scholar 

  21. Rostami K, Kerckhaert J, Tiemessen R, von Blomberg BM, Meijer JW, Mulder CJ. Sensitivity of antiendomysi-um and antigliadin antibodies in untreated celiac disease: disappointing in clinical practice. Am J Gastroenterol. 1994;94:888–94.

    Article  Google Scholar 

  22. Dieterich W, Ehnis T, Bauer M, Donner P, Volta U, Rieck-en EO, et al. Identification of tissue transglutaminase as the autoantigen of celiac disease. Nat Med. 1997;3:797–801.

    Article  CAS  Google Scholar 

  23. Schuppan D, Dieterich W, Ehnis T, Bauer M, Donner P, Volta U, et al. Identification of the autoantigen of celiac disease. Ann NY Acad Sci. 1998;859:121–6.

    Article  CAS  Google Scholar 

  24. Barker CC, Mitton C, Jevon G, Mock T. Can tissue transglutaminase antibody titers replace small-bowel biopsy to diagnose celiac disease in select pediatric populations? Pediatrics. 2005;115:1341–6.

    Article  Google Scholar 

  25. Donaldson MR, Firth SD, Wimpee H, Leiferman KM, Zone JJ, Horsley W, et al. Correlation of duodenal histology with tissue transglutaminase and endomysial antibody levels in pediatric celiac disease. Clin Gastroenterol Hepatol. 2007;5:567–73.

    Article  CAS  Google Scholar 

  26. Donaldson MR, Book LS, Leiferman KM, Zone JJ, Neuhausen SL. Strongly positive tissue transglutaminase antibodies are associated with Marsh 3 histopathology in adult and pediatric celiac disease. J Clin Gastroenterol. 2008;42:256–60.

    CAS  PubMed  Google Scholar 

  27. Hill PG, Holmes GK. Coeliac disease: a biopsy is not always necessary for diagnosis. Aliment Pharmacol Ther. 2008;27:572–7.

    Article  CAS  Google Scholar 

  28. Vivas S, Ruiz de Morales JG, Riestra S, Arias L, Fuentes D, Alvarez N, et al. Duodenal biopsy may be avoided when high transglutaminase antibody titers are present. World J Gastroenterol. 2009;15:4775–80.

    Article  CAS  Google Scholar 

  29. Mubarak A, Wolters VM, Gerritsen SA, Gmelig-Meyling FH, Ten Kate FJ, Houwen RH. A biopsy is not always necessary to diagnose celiac disease. J Pediatr Gastroenterol Nutr. 2011;52:554–7.

    Article  Google Scholar 

  30. Alessio MG, Tonutti E, Brusca I, Radice A, Licini L, Sonzogni A, et al. Study Group on Autoimmune Diseases of Italian Society of Laboratory Medicine. Correlation between IgA tissue transglutaminase antibody ratio and histological finding in celiac disease. J Pediatr Gastroenterol Nutr. 2012;55(1):44–9. doi:10.1097/MPG.0b013e3182470249.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Biochemistry, DMC&H, Ludhiana, Punjab, 141001, India

    Ekta Bansal & Navpreet Kaur

  2. Department of Endocrinology, DMC&H, Ludhiana, Punjab, India

    Naveen Mittal

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  1. Ekta Bansal
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  2. Navpreet Kaur
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Correspondence to Ekta Bansal.

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Authors Ekta Bansal, Navpreet Kaur & Naveen Mittal declare that we have no conflict of interest.

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Bansal, E., Kaur, N. & Mittal, N. Can High Titres of Anti Tissue Transglutaminase Antibodies Reduce the Need for Intestinal Biopsy for Diagnosis of Celiac Disease?. Ind J Clin Biochem 33, 456–460 (2018). https://doi.org/10.1007/s12291-017-0695-9

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  • DOI: https://doi.org/10.1007/s12291-017-0695-9

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