Background and Aims

Anti-tissue transglutaminase antibodies (anti-tTG) have simplified celiac disease (CD) diagnosis. However, in atypical forms of CD, intestinal biopsy sampling is still required. This prospective study investigates whether histologic analysis of the duodenal bulb combined with intestinal IgA anti-tTG deposit immunoassay makes CD diagnosis possible in at-risk children with low concentrations of serum anti-tTG.

Methods

Histologic and intestinal IgA anti-tTG deposit immunoassays were used.

Results

Two hundred forty-five symptomatic children positive for serum anti-tTG (>7 U/mL) were enrolled and divided into 3 groups: extensive duodenal atrophy (n = 209), with IgA anti-tTG deposits throughout the duodenum and high serum anti-tTG concentrations (157 ± 178 U/mL); bulb duodenal atrophy (n = 22), with widespread IgA anti-tTG deposits in 9 and in the bulb alone in 13 and low serum anti-tTG concentrations (13.9 ± 8.7 U/mL); and normal duodenum (n = 14), with widespread IgA anti-tTG deposits in 8 and in the bulb alone in 6 and low serum anti-tTG concentrations (10.6 ± 6.2 U/mL). All patients in the first 2 groups were diagnosed with CD and 8 from the third group. All improved after 1 year of gluten-free diet. Bulb duodenal analysis led to a 12% (30/245) increase in CD diagnosis. No CD-related lesions were observed in the 30 control subjects.

Conclusions

In children at risk for CD, bulb duodenum biopsy sampling is essential to identify villous atrophy and detect IgA anti-tTG deposits even in absence of intestinal lesions. These mucosal autoantibodies could well represent a new standard for diagnosing CD.

中文翻译：

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十二指肠球的免疫组织学分析：一种诊断儿童乳糜泻的新方法

背景和目标

抗组织转谷氨酰胺酶抗体（anti-tTG）具有简化的乳糜泻（CD）诊断。但是，在非典型CD形式中，仍需要进行肠道活检取样。这项前瞻性研究调查了十二指肠球的组织学分析与肠道IgA抗tTG沉积物免疫测定相结合是否可以在低浓度血清抗tTG的高危儿童中进行CD诊断。

方法

使用了组织学和肠道IgA抗tTG沉积免疫测定。

结果

招募了255位血清抗tTG（> 7 U / mL）阳性的症状儿童，并分为3组：广泛的十二指肠萎缩（n = 209），在整个十二指肠中有IgA抗tTG沉积物和高血清抗-tTG浓度（157±178 U / mL）; 球囊十二指肠萎缩（n = 22），其中9处广泛存在IgA抗tTG沉积物，仅13处存在于灯泡中，血清抗tTG浓度低（13.9±8.7 U / mL）；和正常的十二指肠（n = 14），在8个球囊中普遍存在IgA抗tTG沉积物，在球茎中仅以6个球囊沉积，并且血清抗tTG浓度较低（10.6±6.2 U / mL）。前2组的所有患者均被诊断为CD，第三组为8例。无麸质饮食1年后所有症状均得到改善。灯泡十二指肠分析导致CD诊断增加12％（30/245）。在30名对照受试者中未观察到与CD相关的病变。

结论

对于有CD风险的儿童，即使在没有肠道病变的情况下，十二指肠球囊活检取样对于识别绒毛萎缩和检测IgA抗tTG沉积也是必不可少的。这些粘膜自身抗体很可能代表了诊断CD的新标准。