Citations 2
Positive Predictive Value of Tissue Transglutaminase IgA for Celiac Disease
Wong, Madison , Cárdenas, María C. , Stahl, Marisa G. , Liu, Edwin , Caplan, Mayan, Gidrewicz, Dominica , Leonard, Maureen M. , Pacheco, M. Cristina, Dickerson, Jane A. , Raber, Catherine , Badalyan, Vahe , Chugh, Ankur , Baek, Clara, Singh, Arunjot , Fahey, Lisa M. , Walsh, Catharine M. , Silvester, Jocelyn A. , Absah, Imad , Camila Cardenas, Maria, Silvester, Jocelyn A , Walsh, Catharine M , Chang, Denis , Caplan, Mayan, King, James A. , Turner, Justine , Lee, Dale Young , Setty, Mala , Baek, Clara
Pediatrics | August 8, 2025 | Volume: 156 | Issue: 3 | Pages: No page available
BACKGROUND AND OBJECTIVES Recent changes in European diagnostic criteria allow for serologic diagnosis of celiac disease in children. Those guidelines have not been adopted in North America; hence, we aim to assess the positive predictive value (PPV) of tissue transglutaminase (tTG) immunoglobulin A (IgA) assays used in North America in identifying histologic findings of celiac disease. METHODS Multicenter retrospective cohort study of children (<18 years) with an elevated tTG IgA within 6 months of an esophagogastroduodenoscopy between January 2016 and December 2021. Biopsy-confirmed celiac disease was determined by the presence of intraepithelial lymphocytosis and villous atrophy. The primary outcomes were the PPV of an elevated tTG IgA and tTG IgA greater than or equal to 10 times the upper limit of normal (10× ULN). RESULTS Overall, 4019 children (63.3% female; 9% type 1 diabetes, 2% Down syndrome) were included. Histologic findings were consistent with celiac disease for 3321 children (PPV = 82.6% [95% CI, 81.4–83.8]). Among the 1739/4019 (43.2%) children with tTG IgA greater than or equal to 10× ULN, 1651 had biopsy-confirmed celiac disease (PPV10× = 94.9% [95% CI, 93.8–95.9]). Five percent (88/1739) of children did not have histologic findings of celiac disease, including 41/1739 (2%) with normal histology. Diagnostic accuracy of tTG IgA varied widely among assays used in North America (PPV range: 71.5%–88.8%; PPV10× range: 89.3%–97.3%). Assays performed worse in children with type 1 diabetes (PPV10× 89% [95% CI, 83.5–92.8]). CONCLUSIONS Elevated tTG IgA in isolation is insufficient to confidently diagnose celiac disease. As tTG assay performance varied widely, diagnostic confirmation by a specialist prior to dietary changes is essential.
Assessing Mucosal Recovery During the First 15 Months of Adopting a Gluten-Free Diet in Children With Celiac Disease
Chang, Denis , Wong, Madison , Davidowitz, Cleo R., Absah, Imad , Badalyan, Vahe , Chaaban, Mohammad Karam, Fahey, Lisa M. , Isaac, Daniela Migliarese , Khanna, Maya, Lansing, Marihan, Liu, Edwin , Raber, Catherine , Singh, Arunjot , Stahl, Marisa G. , Walsh, Catharine M. , Silvester, Jocelyn A. , Leonard, Maureen M. , Chaaban, Mohammad K, Silvester, Jocelyn A , Walsh, Catharine M , Khanna, Maya
American Journal of Gastroenterology | March 14, 2025 | Volume: 120 | Issue: 7 | Pages: 1657-1661
INTRODUCTION: Determine contemporary rates of early mucosal recovery in children with celiac disease (CeD). METHODS: Multicenter retrospective cohort study in Canada and the United States. Children diagnosed with CeD between 2016 and 2021 who underwent a follow-up biopsy within 15 months of diagnosis were included. RESULTS: Overall, 96 of 130 children (74%) had mucosal recovery, including 48% children (12/25) who were assessed within 3 months. Musculoskeletal symptoms at diagnosis were the only clinical characteristic associated with persistent enteropathy. DISCUSSION: While mucosal recovery can occur within months, more than a quarter of children with CeD had persistent enteropathy within 15 months of treatment.