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Cited by 41Celiac Disease Research and ManagementEosinophilic EsophagitisWheat and Barley Genetics and Pathology

Follow-up of pediatric celiac disease: value of antibodies in predicting mucosal healing, a prospective cohort study

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Vécsei, Edith, Steinwendner, Stephanie, Kogler, Hubert, Innerhofer, Albina, Hammer, Karin, Haas, Oskar A, Amann, Gabriele, Chott, Andreas +4 more·2014·BMC Gastroenterology
DOI 10.1186/1471-230x-14-28PMC PMC3937029
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Abstract

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 13-43) 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.

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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 [85]

    The Results > Histology section reports persistent villous atrophy (Marsh 3) in 5 of 53 children, about 9.4%, which falls within the cited range. The Methods > Study design and subjects section gives a median gluten-free-diet duration of 2.2 years, but the range was 1–12.9 years. This paper therefore supports an example within the prevalence range, not the full 2%–19% range specifically at 1–3 years after diagnosis. (LLM, conf=0.86)

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  • Negative endomysial autoantibodies most reliably predict mucosal healing.

    “The study also found that negative EmA most reliably predicts mucosal healing (85).”

    From ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease. (2022) · cites this paper as [85]

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Authors
Vécsei, E., Steinwendner, S., Kogler, H., Innerhofer, A., Hammer, K., Haas, O. A., Amann, G., Chott, A., Vogelsang, H., Schoenlechner, R., Huf, W., & Vécsei, A.
Affiliations
  • St Anna Children's Hospital (AT)
  • Medical University of Vienna (AT)
  • Wilhelminen Hospital (AT)
Corresponding author
Vécsei, Andreas
ORCID
Venue
BMC Gastroenterology
Publisher
Springer Science and Business Media LLC
Published
2014-02-13
Volume
14
Issue
1
Pages
28-28
ISSN
1471-230X (ISSN-L)
DOI
10.1186/1471-230x-14-28
PMC
PMC3937029
OpenAlex
W2031954292
Cited by
41
References
34
Citations by year
2026: 1 · 2025: 5 · 2023: 5 · 2022: 3 · 2021: 3 · 2020: 3 · 2019: 2 · 2018: 3 · 2017: 6 · 2016: 8 · 2015: 2
FWCI
5.35
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Gastroenterology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • BOK:ePub (Universitätsbibliothek der Universität f Bodenkultur Wien) (submittedVersion)
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
pediatric celiac disease, mucosal healing, serological antibodies, anti-tissue transglutaminase antibodies, deamidated gliadin peptide antibodies, anti-endomysial antibodies, gluten-free diet, Marsh classification, small bowel biopsy, diagnostic accuracy
MeSH terms
Protein Glutamine gamma Glutamyltransferase 2, Adolescent, Biopsy, Celiac Disease, Child, Child, Preschool, Cross-Sectional Studies, Female, Follow-Up Studies, Gliadin, Humans, Immunoglobulin A, Immunoglobulin G, Intestinal Mucosa, Intestine, Small, Male, Peptide Fragments, Prospective Studies, Transglutaminases, Sensitivity and Specificity, Wound Healing, Endoscopy, Gastrointestinal, GTP-Binding Proteins, Diet, Gluten-Free, Young Adult

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