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Open Access Highly Accessed Research article

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

Edith Vécsei1, Stephanie Steinwendner1, Hubert Kogler1, Albina Innerhofer1, Karin Hammer1, Oskar A Haas1, Gabriele Amann2, Andreas Chott3, Harald Vogelsang4, Regine Schoenlechner5, Wolfgang Huf6 and Andreas Vécsei1*

Author Affiliations

1 Department of Pediatrics, Pediatric Gastroenterology, St. Anna Children's Hospital, Medical University Vienna, Kinderspitalgasse 6, 1090 Vienna, Austria

2 Clinical Department of Pathology, Medical University Vienna, Vienna, Austria

3 Institute of Pathology and Microbiology, Wilhelminenspital, Vienna, Austria

4 Department of Internal Medicine III, Division for Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria

5 Department of Food Science and Technology, Institute of Food Technology, University of Natural Resources and Life Sciences, Vienna, Austria

6 Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria

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BMC Gastroenterology 2014, 14:28  doi:10.1186/1471-230X-14-28

Published: 13 February 2014

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.

Keywords:
Pediatrics; Celiac disease; Follow-up; Endomysial antibodies; Sensitivity; Specificity