Can Celiac Serology Alone be Used as a Marker of Duodenal Mucosal Recovery in Children with Celiac Disease on a Gluten-Free Diet?
Abstract
Objectives Assessment of treatment response in children with celiac disease (CD) after commencing a strict gluten-free diet (GFD) is generally based on the resolution of clinical features and normalization of serology. Recent adult studies have shown that serologic markers do not correlate with mucosal recovery. We aimed (i) to determine whether anti-tissue transglutaminase immunoglobulin (Ig)A (tTG) and anti-deamidated gliadin peptide IgG (DGP) antibodies are sensitive and specific markers of mucosal recovery in children with CD on a GFD for at least 12 months, and (ii) to determine whether a validated dietary questionnaire of compliance can identify patients with mucosal recovery. Methods A total of 150 children with biopsy-proven CD were prospectively evaluated with duodenal biopsies at ≥12 months on GFD, paired with repeat tTG and DGP serology. The biopsies were reviewed in a blinded manner by two histopathologists and graded by Marsh criteria. A validated questionnaire of dietary compliance was also administered. Results Of 150 children recruited, 27 (18%) had positive serology, 97 (65%) had negative serology, and 26 (17%) had equivocal serology. Of the 97 children with negative serology, none had Marsh type 3 enteropathy. Of the 27 patients with positive serology, only 6 had Marsh type 3 changes. The sensitivity and specificity of serology as a marker of significant mucosal pathology was 75 and 85%, respectively, with a positive predictive value of 22% but a negative pr…
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In the scarce literature regarding persisting villous atrophy in celiac disease children on a gluten-free diet, the prevalence was 2%-19% at 1-3 years after diagnosis.
“In the scarce literature regarding persisting villous atrophy in CD children on a GFD, we found a prevalence of 2%-19% at 1-3 years after CD diagnosis (75, 85-89).”
From ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease. (2022) · cites this paper as [75]
Celiac disease serology markers IgA-TGA and endomysial autoantibodies work very well for diagnosis but are less accurate for dietary monitoring.
“Although CD serology markers (IgA-TGA and endomysial autoantibodies (EmA)) work very well for diagnosis, these are less accurate for dietary monitoring (74, 75).”
From ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease. (2022) · cites this paper as [75]
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ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease.
Mearin, M. L., Agardh, D., Antunes, H., Al‐toma, A., Auricchio, R., Castillejo, G., Catassi, C., Ciacci, C., Discepolo, V., Dolinsek, J., et al. (2022) · Journal of pediatric gastroenterology and nutrition · doi:10.1097/mpg.0000000000003540 · Cited by 186 · see citing works
Szakács, Z., Mátrai, P., Hegyi, P., Szabó, I., Vincze, Á., Balaskó, M., Mosdósi, B., Sarlós, P., Simon, M., Márta, K., et al. (2017) · PLOS ONE · doi:10.1371/journal.pone.0187526 · Cited by 35 · see citing works
Antitissue Transglutaminase Normalization Postdiagnosis in Children With Celiac Disease
Isaac, D. M., Rajani, S., Yaskina, M., Huynh, H. Q., & Turner, J. M. (2017) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000001480 · Cited by 33 · see citing works
- Authors
- Bannister, E. G., Cameron, D. J., Ng, J., Chow, C. W., Oliver, M. R., Alex, G., Catto-Smith, A. G., Heine, R. G., Webb, A., McGrath, K., Simpson, D., & Hardikar, W.
- Affiliations
- Royal Children's Hospital (AU)
- Corresponding author
- Hardikar, Winita
- ORCID
- Venue
- American Journal of Gastroenterology
- Published
- 2014-09
- Volume
- 109
- Issue
- 9
- Pages
- 1478-1483
- ISSN
- 0002-9270 (ISSN-L)
- OpenAlex
- W1986911066
- Cited by
- 56
- References
- 0
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 4 · 2022: 4 · 2021: 5 · 2020: 5 · 2019: 5 · 2018: 2 · 2017: 11 · 2016: 7 · 2015: 2
- FWCI
- 6.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
- Health Sciences › Medicine › Surgery › Eosinophilic Esophagitis
- Life Sciences › Agricultural and Biological Sciences › Plant Science › Wheat and Barley Genetics and Pathology
- Keywords
- celiac disease, gluten-free diet, anti-tissue transglutaminase antibodies, deamidated gliadin peptide antibodies, serological markers, treatment response monitoring, children
- MeSH terms
- Protein Glutamine gamma Glutamyltransferase 2, Adolescent, Celiac Disease, Child, Child, Preschool, Duodenum, Female, Gliadin, Humans, Immunoglobulin A, Immunoglobulin G, Infant, Intestinal Mucosa, Male, Patient Compliance, Predictive Value of Tests, Prospective Studies, Transglutaminases, Surveys and Questionnaires, Biomarkers, GTP-Binding Proteins, Diet, Gluten-Free
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