Eviz Elif, Sari Sinan, Uslu Kizilkan Nuray, Doger Esra, Yesiltepe Mutlu Gul, Eğritaş Ödül, Arikan Cigdem, Bideci Aysun, Dalgic Buket, Hatun Sukru
Department of Pediatric Endocrinology and Diabetes, Faculty of Medicine, Koc University, Istanbul, Turkey.
Department of Pediatric Gastroenterology, Faculty of Medicine, Gazi University, Ankara, Turkey.
Dig Dis. 2025;43(2):225-234. doi: 10.1159/000543168. Epub 2025 Jan 8.
Celiac disease (CD)-related antibody positivity in children with type 1 diabetes (T1D) may fluctuate and become negative spontaneously. There are uncertainties about the optimal tissue transglutaminase IgA (tTG-IgA) titre and timing of endoscopy in the diagnosis of CD, and this study aimed to contribute to the debate on the tTG-IgA threshold titre for endoscopy decisions in children with T1D.
The data of 991 children with T1D who had undergone serologic evaluation for CD were analysed retrospectively. The tTG-IgA positivity rate and the upper limit of normal (ULN) tTG-IgA positivity were assessed. Participants were grouped according to the frequency, course, and test results of tTG-IgA tests. Those with and without histopathologic diagnosis of CD by endoscopic biopsy were compared in terms of tTG-IgA screening time and tTG-IgA predictive values.
In 10.2% (n:101) of all cases, tTG-IgA antibody was positive and endoscopic biopsy was performed in 68.3% (n:69) of these cases. Of all cases, 4.3% (n:43) were diagnosed with CD by endoscopic biopsy. A tTG-IgA titre of 7×ULN and above was found to be the best predictive value for the diagnosis of CD with 79.1% sensitivity, 80.8% specificity 87.2% positive predictive value, and 70% negative predictive value.
Approximately 10% of antibody positive cases showed fluctuating and low-titre positivity, and no CD was detected by endoscopic biopsy in the group with fluctuating antibody course. The results of our study suggest that endoscopy in children with tTG-IgA levels 7×ULN or above may prevent both false-positive results and missed cases.
1型糖尿病（T1D）患儿中与乳糜泻（CD）相关的抗体阳性可能会波动并自发转阴。在CD诊断中，对于组织转谷氨酰胺酶IgA（tTG-IgA）的最佳滴度以及内镜检查的时机存在不确定性，本研究旨在为T1D患儿内镜检查决策的tTG-IgA阈值滴度的讨论提供参考。
回顾性分析991例接受CD血清学评估的T1D患儿的数据。评估tTG-IgA阳性率和正常上限（ULN）tTG-IgA阳性情况。根据tTG-IgA检测的频率、过程和结果对参与者进行分组。比较经内镜活检有和无CD组织病理学诊断的患者在tTG-IgA筛查时间和tTG-IgA预测值方面的差异。
在所有病例中，10.2%（n = 101）的tTG-IgA抗体呈阳性，其中68.3%（n = 69）的病例进行了内镜活检。在所有病例中，4.3%（n = 43）经内镜活检诊断为CD。发现tTG-IgA滴度达到7×ULN及以上时，对CD诊断的预测价值最佳，灵敏度为79.1%，特异度为80.8%，阳性预测值为87.2%，阴性预测值为70%。
约10%的抗体阳性病例显示出波动的低滴度阳性，抗体过程波动组经内镜活检未检测到CD。我们的研究结果表明，tTG-IgA水平达到7×ULN或以上的儿童进行内镜检查可避免假阳性结果和漏诊病例。
