Is tissue transglutaminase autoantibody the best for diagnosing celiac disease in children of developing countries?

AIM

To prospectively evaluate the role of tissue transglutaminase (tTG) antibody in detecting celiac disease (CD) in Indian children.

METHODS

Over a period of 3 years, 333 children (<or=14 y of age) with suspected CD were evaluated. CD was diagnosed on the basis of modified ESPGHAN criteria. Antibody to tTG (guinea-pig) was detected by commercial enzyme-linked immunosorbent assay kit. Children with a suspicion of CD but found to have normal villous architecture were taken as controls. Antiendomysial antibody (EMA) and IgA-antigliadin antibody were done in 80 cases and 40 controls.

RESULTS

The mean age of 180 children with CD was 6.5+/-3 years with a male to female ratio of 1.7:1. Their presenting complaints were diarrhea in 84% and failure to thrive in 87%. Wasting, stunting, and anemia were seen in 87%, 59%, and 83% of cases, respectively. The best sensitivity and specificity of tTG antibody we have got at a cut-off value of 10 U/mL and were 94% and 97%, respectively, with a positive predictive value of 98% and negative predictive value of 92.4%. The mean tTG antibody titer was 106+/-76 U/mL in cases and 2+/-1.6 U/mL in controls (P<0.001). The concordance of tTG antibody with EMA was 95% in cases and 97.5% in controls.

CONCLUSIONS

tTG antibody is a highly sensitive and specific serologic marker. Being technically simpler and due to its high concordance with EMA, it can be used as an alternative to EMA in developing countries like India.