Research Article
Is a Small Intestinal Biopsy Always Necessary to Diagnose Celiac Disease in Children?
Serge A. Sorser1, Tammy Tran1, Karen Hagglund3, Alexander Lyons2, Hernando Lyons3* and Kamran Kalim1
1Department of Gastroenterology, Providence Hospital, Southfield, MI, USA
2Department of Pediatric Gastroenterology, St. John Hospital and Medical Center, Detroit, MI, USA
3Department of Medical Education, St. John Hospital and Medical Center, Detroit, MI, USA
- Corresponding Author:
- Serge A. Sorser
MD, 16001 W. 9 Mile Rd., Southfield, MI 48075, USA
Tel: 248-560-1770
Fax: 248-443-2439
E-mail: ssorser@gmail.com
Received Date: February 10, 2015; Accepted Date: April 05, 2016; Published Date: April 11, 2016
Citation: Sorser SA, Tran T, Hagglund K, Lyons A, Lyons H, et al. (2016) Is a Small Intestinal Biopsy Always Necessary to Diagnose Celiac Disease in Children?. J Gastrointest Dig Syst 6:412. doi:10.4172/2161-069X.1000412
Copyright: © 2016 Sorser SA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Objectives: The purpose of this study was to assess the diagnostic accuracy of the tissue transglutaminase antibody (tTG-Ab) for celiac disease (CD) in children.
Methods: A retrospective chart review of children suspected to have CD from January 2007 to December 2011 was conducted. Patients were excluded if they had an Immunoglobulin A (IgA) deficiency, an autoimmune disorder or were following a gluten-free diet at the time of presentation. Gender, age at the time of small bowel biopsy, chief complaint, family history of celiac disease, serum IgA and tTG-Ab were recorded. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of tTG-Ab compared to biopsy result were calculated, using three different cut-off values of tTG-Ab: >100 U/mL, >200 U/mL, and >300 U/mL.
Results: 174 patients were included. 51% were male and the mean ± SD age was 9.8 ± 5.0 years. Chief complaints included abdominal pain (63.8%), diarrhea (14.9%), failure to thrive (14.4%), and vomiting (12.1%). 11.5% (20) of the patients had a family history of CD. 22 (13%) had a positive biopsy and 51(29%) had an abnormal tTG Ab level, with 13 patients >100 U/mL, 12 patients >200 U/mL, and 10 patients >300 U/mL. The specificity and PPV for the three groups were 97% and 77%, 99% and 92%, 100% and 100% respectively.
Conclusion: Low sensitivity precludes the use of tTG-Ab as a screening test, although tTG-Ab >300 U/mL has a very high specificity and PPV for celiac disease. In pediatric patients with clinical features suggestive of celiac disease, a tTG-Ab of >300 U/mL may be used to diagnose CD, avoiding duodenal biopsy.
