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Cited by 97Celiac Disease Research and ManagementEosinophilic EsophagitisWheat and Barley Genetics and Pathology

Value of IgA tTG in Predicting Mucosal Recovery in Children With Celiac Disease on a Gluten‐Free Diet

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Leonard, Maureen M., Weir, Dascha C., DeGroote, Maya, Mitchell, Paul D., Singh, Prashant, Silvester, Jocelyn A., Leichtner, Alan M., Fasano, Alessio·2017·Journal of Pediatric Gastroenterology and Nutrition
DOI 10.1097/mpg.0000000000001460PMC PMC5457911
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Abstract

Objectives: Our objective was to determine the rate of mucosal recovery in pediatric patients with celiac disease on a gluten‐free diet. We also sought to determine whether immunoglobulin A tissue transglutaminase (tTG) correlates with mucosal damage at the time of a repeat endoscopy with duodenal biopsy in these patients. Methods: We performed a retrospective chart review of 103 pediatric patients, younger than 21 years, with a diagnosis of celiac disease defined as Marsh 3 histology, and who underwent a repeat endoscopy with duodenal biopsy at least 12 months after initiating a gluten‐free diet. Results: We found that 19% of pediatric patients treated with a gluten‐free diet had persistent enteropathy. At the time of the repeat biopsy, tTG was elevated in 43% of cases with persistent enteropathy and 32% of cases in which there was mucosal recovery. Overall the positive predictive value of the autoantibody tTG was 25% and the negative predictive value was 83% in patients on a gluten‐free diet for a median of 2.4 years. Conclusions: Nearly 1 in 5 children with celiac disease in our population had persistent enteropathy despite maintaining a gluten‐free diet and immunoglobulin A tTG was not an accurate marker of mucosal recovery. Neither the presence of symptoms nor positive serology were predictive of a patient's histology at the time of repeat biopsy. These findings suggest a revisitation of monitring and management criteria of celiac disease in childhood.

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  • Gastrointestinal symptoms, with or without slightly elevated celiac disease antibodies, may persist in a small percentage of children claiming optimal dietary adherence.

    “Gastrointestinal symptoms, with or without slightly elevated CD antibodies, may persist in a small percentage of children claiming optimal dietary adherence (86, 87)”

    From ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease. (2022) · cites this paper as [86]

    The Results (Patient Characteristics at Repeat Biopsy, page unavailable) report persistent symptoms in 43% of this repeat-endoscopy cohort, persistently elevated serology in 34%, and excellent gluten-free-diet adherence in 91%. This supports the possibility of symptoms despite reported adherence, but the paper does not characterize the antibody elevations as slight or establish that symptoms persist in only a small percentage of children generally. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • 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 [86]

    The Discussion reports persistent enteropathy in 19% of children in this study and cites other pediatric estimates of 5%, 9%, and 15%. It does not establish a 2% lower bound. Results (Patient Characteristics at Repeat Biopsy, Table 2) gives a median of 2.4 years on a gluten-free diet but a range of 1–12 years, not a prevalence specifically at 1–3 years after diagnosis. Page numbers are unavailable in our copy. (LLM, conf=0.88)

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Authors
Leonard, M. M., Weir, D. C., DeGroote, M., Mitchell, P. D., Singh, P., Silvester, J. A., Leichtner, A. M., & Fasano, A.
Affiliations
  • Harvard University (US)
  • Boston Children's Hospital (US)
  • Massachusetts General Hospital (US)
Corresponding author
  • Leonard, Maureen M.
  • Fasano, Alessio
ORCID
Venue
Journal of Pediatric Gastroenterology and Nutrition
Publisher
Wiley
Published
2017-02
Volume
64
Issue
2
Pages
286-291
ISSN
  • 0277-2116 (ISSN-L)
  • 1536-4801
DOI
10.1097/mpg.0000000000001460
PMC
PMC5457911
OpenAlex
W2548607618
Cited by
97
References
1
Citations by year
2026: 6 · 2025: 14 · 2024: 11 · 2023: 8 · 2022: 11 · 2021: 8 · 2020: 12 · 2019: 10 · 2018: 6 · 2017: 10 · 2016: 1
FWCI
9.85
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of Pediatric Gastroenterology and Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Diabetes and Digestive and Kidney Diseases (5 P30 DK34854)
  • National Center for Research Resources
  • National Center for Advancing Translational Sciences
  • Academy of Natural Sciences of Drexel University
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, pediatric celiac disease, gluten-free diet, mucosal recovery, anti-tissue transglutaminase antibodies, duodenal biopsy, serological surveillance, duodenal injury
MeSH terms
Protein Glutamine gamma Glutamyltransferase 2, Adolescent, Biopsy, Celiac Disease, Child, Child, Preschool, Duodenoscopy, Duodenum, Female, Follow-Up Studies, Humans, Immunoglobulin A, Infant, Infant, Newborn, Intestinal Mucosa, Male, Predictive Value of Tests, Transglutaminases, Retrospective Studies, Biomarkers, Treatment Outcome, GTP-Binding Proteins, Diet, Gluten-Free, Young Adult

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