Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2022 Sep;58(9):1648-1652. doi: 10.1111/jpc.16071. Epub 2022 Jun 21.
Deamidated gliadin peptide-IgG (DGP-IgG) antibody serology testing is widely utilised in screening for coeliac disease in Australia; however, it is used sparingly in Europe. The aim of this study was to assess the diagnostic value of a positive DGP-IgG in the setting of a negative tissue transglutaminase-IgA (tTG-IgA) for gastrointestinal pathology among paediatric patients.
We conducted a retrospective cohort study of all children with an elevated DGP-IgG in the setting of a negative tTG-IgA who underwent gastroscopy over a 48-month period (January 2015-December 2018) at a tertiary paediatric centre. They were identified utilising the electronic pathology database and demographic and clinical data were collected from electronic medical records. Patients who had previously been diagnosed with coeliac disease were on a gluten-free diet or over the age of 18 were excluded from the study.
Twenty-six patients with an elevated DGP-IgG in the setting of a negative tTG-IgA underwent gastroscopy. Our study yielded a positive predictive value of 1/26 (3.9% CI 95% 0.7%, 18.9%) for the diagnosis of coeliac disease. Overall, there were 25 histopathological diagnoses including 1 diagnosis of coeliac disease among the total 26 patients who were positive DGP-IgG and negative tTG-IgA and underwent gastroscopy.
Our findings suggest that an isolated positive DGP-IgG has a very low diagnostic yield for coeliac disease in children and may be indicative of other gastrointestinal pathology.
脱酰胺麦谷蛋白肽 IgG（DGP-IgG）抗体血清学检测在澳大利亚被广泛用于筛查乳糜泻；然而，在欧洲却很少使用。本研究旨在评估在组织转谷氨酰胺酶 IgA（tTG-IgA）阴性的情况下，阳性 DGP-IgG 对儿科患者胃肠道病理的诊断价值。
我们对在 48 个月期间（2015 年 1 月至 2018 年 12 月）在一家三级儿科中心接受内窥镜检查的所有 DGP-IgG 升高且 tTG-IgA 阴性的儿童进行了回顾性队列研究。他们是通过电子病理学数据库识别的，从电子病历中收集了人口统计学和临床数据。已被诊断患有乳糜泻的患者或已接受无麸质饮食或年龄超过 18 岁的患者被排除在研究之外。
26 例 DGP-IgG 升高且 tTG-IgA 阴性的患者接受了内窥镜检查。我们的研究得出的阳性预测值为 1/26（3.9%置信区间 95%为 0.7%，18.9%），用于诊断乳糜泻。总体而言，在 26 例 DGP-IgG 阳性且 tTG-IgA 阴性并接受内窥镜检查的患者中，有 25 例组织病理学诊断，包括 1 例乳糜泻诊断。
我们的研究结果表明，孤立的阳性 DGP-IgG 对儿童乳糜泻的诊断率非常低，可能提示其他胃肠道病理。
