engleski

CELIAC DISEASE SCREENING ASSAYS IN CHILDREN YOUNGER THAN 3 YEARS OF AGE–IS THE IGARIGG DGP ASSAY HELPFUL?

Objectives and Study: Early detection and treatment of CD can prevent growth failure and disease complications. Therefore, screening for CD is recommended for a wide variety of symptoms, but also in asymptomatic patients from different risk groups. It is well known that for the diagnosis of CD highly specific serologic tests are needed. Anti-endomesial antibody (EMA) and anti-tissue transglutaminase (TTG) have high sensitivity and specificity. Other tests include the recently introduced antibodies against deamidated gliadin peptides (DGP) that seems to be useful, but less accurate than TTG. The optimal serologic test for celiac disease (CD) in young children is not known. The aim of our study was to compare the performance of three serological tests (IgAþIgG DGP, IgA TTG and IgAþIgG EMA) in children younger than 3 years of age. Methods: We identified all subjects younger than 3 years of age (n¼6074) that were tested for CD serology and included those with biopsy data.. Patients were classified as group 1 (n¼47): patients with confirmed CD or group 2 (n¼12): patients with normal biopsy findings Results: There was statistically significant difference between group 1 and group 2 in regard to positivity for IgAþIgG DGP (100% vs 77.78%, P¼0.007), IgA TTG (97.87% vs 50%, P<0.001), and IgAþIgG EMA (95.65% vs 9.09%, P<0.001). Suggested manufacturer’s cutoff levels had high sensitivity for all tests (IgAþIgG DGP 100%, IgA TTG 97%, IgAþIgG EMA 96%), however specificity was low for IgAþIgG DGP (44%), IgA TTG (50%) but not for IgAþIgG EMA (91%). Conclusion: Our current study showed that all 3 used tests (IgA TTG, IgAþIgG DGP and IgAþIgG EMA) have high sensitivity in children younger than 3 years of age. However, EMA was the only test that proved to be specific, and the addition of TTG or DGP did not provide a significant added value. In children younger than 3 years of age, only EMA is both highly sensitive and specific in predicting biopsy findings. This suggests that in patients with positive DGP and negative EMA, biopsy might be postponed as long

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