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Titel
Follow-up of pediatric celiac disease: value of antibodies in predicting mucosal healing, a prospective cohort study
VerfasserVécsei, Edith ; Steinwendner, Stephanie ; Kogler, Hubert ; Innerhofer, Albina ; Hammer, Karin ; Haas, Oskar A. ; Amann, Gabriele ; Chott, Andreas ; Vogelsang, Harald ; Schoenlechner, Regine ; Huf, Wolfgang ; Vécsei, Andreas
Erschienen in
BMC Gastroenterology, 2014, Jg. 14,
ErschienenBioMed Central (BMC), 2014
SpracheEnglisch
DokumenttypAufsatz in einer Zeitschrift
Schlagwörter (EN)Pediatrics / Celiac disease / Follow-up / Endomysial antibodies / Sensitivity / Specificity
ISSN1471-230X
URNurn:nbn:at:at-ubbw:3-490 Persistent Identifier (URN)
DOIdoi:10.1186/1471-230X-14-28 
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Follow-up of pediatric celiac disease: value of antibodies in predicting mucosal healing, a prospective cohort study [0.23 mb]
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Zusammenfassung (Englisch)

Background:

In diagnosing celiac disease (CD), serological tests are highly valuable. However, their role in following up children with CD after prescription of a gluten-free diet is unclear. This study aimed to compare the performance of antibody tests in predicting small-intestinal mucosal status in diagnosis vs. follow-up of pediatric CD.

Methods:

We conducted a prospective cohort study at a tertiary-care center. 148 children underwent esophohagogastroduodenoscopy with biopsies either for symptoms positive CD antibodies (group A; n = 95) or following up CD diagnosed 1 year before study enrollment (group B; n = 53). Using biopsy (Marsh 2) as the criterion standard, areas under ROC curves (AUCs) and likelihood-ratios were calculated to estimate the performance of antibody tests against tissue transglutaminase (TG2), deamidated gliadin peptide (DGP) and endomysium (EMA).

Results:

AUCs were higher when tests were used for CD diagnosis vs. follow-up: 1 vs. 0.86 (P = 0.100) for TG2-IgA, 0.85 vs. 0.74 (P = 0.421) for TG2-IgG, 0.97 vs. 0.61 (P = 0.004) for DPG-IgA, and 0.99 vs. 0.88 (P = 0.053) for DPG-IgG, respectively. Empirical power was 85% for the DPG-IgA comparison, and on average 33% (range 1343) for the non-significant comparisons. Among group B children, 88.7% showed mucosal healing (median 2.2 years after primary diagnosis). Only the negative likelihood-ratio of EMA was low enough (0.097) to effectively rule out persistent mucosal injury. However, out of 12 EMA-positive children with mucosal healing, 9 subsequently turned EMA-negative.

Conclusions:

Among the CD antibodies examined, negative EMA most reliably predict mucosal healing. In general, however, antibody tests, especially DPG-IgA, are of limited value in predicting the mucosal status in the early years post-diagnosis but may be sufficient after a longer period of time.