PMID- 23783015
OWN - NLM
STAT- MEDLINE
DCOM- 20140418
LR  - 20220408
IS  - 1536-4801 (Electronic)
IS  - 0277-2116 (Linking)
VI  - 57
IP  - 4
DP  - 2013 Oct
TI  - Transglutaminase IgA antibodies in a celiac disease mass screening and the role 
      of HLA-DQ genotyping and endomysial antibodies in sequential testing.
PG  - 472-6
LID - 10.1097/MPG.0b013e31829ef65d [doi]
AB  - OBJECTIVES: The aim of this study was to evaluate hypothetical screening 
      strategies in a Swedish celiac disease (CD) mass screening. METHODS: Of 10,041 
      Swedish sixth graders born in 1993 invited to a population-based CD mass 
      screening, 7208 participated. Anti-tissue transglutaminase (tTG) immunoglobulin 
      (Ig) A were analyzed in all children and total serum IgA (s-IgA) in 7161 
      children. Additional analyses of tTG-IgG, endomysial antibodies (EMA) IgA and 
      IgG, and human leukocyte antigen (HLA) alleles were performed according to a 
      standardized protocol. Children with elevated levels of serological markers were 
      recommended to undergo a small intestinal biopsy to verify diagnosis, and 153 
      children with CD were thus identified. Sensitivity, specificity, positive 
      predictive values (PPVs) and negative predictive values (NPVs) were calculated 
      and receiver operating characteristic curves were plotted. RESULTS: By lowering 
      the cutoff for tTG-IgA, 17 additional cases of CD were identified at the cost of 
      32 biopsies. All children with tTG-IgA >50 U/mL (10 times the recommended upper 
      limit of normal) had gluten enteropathy. Area under the receiver operating 
      characteristic curve for tTG-IgA was 0.988. All cases carried HLA-DQ2 or HLA-DQ8, 
      as did 53% of the controls. For different hypothetical screening strategies, 
      sensitivity, specificity, PPV, and NPV ranged between 87.6% and 100%, 99.5% and 
      99.9%, 79.7% and 89.7%, and 99.7% and 100%, respectively. Efforts to increase 
      sensitivity by lowering tTG-IgA cutoff would result in increased number of small 
      intestinal biopsies and lower PPV. Sequential testing for both EMA and HLA-DQ 
      genotyping would reduce the number of negative small intestinal biopsies. 
      CONCLUSIONS: tTG-IgA is a robust marker when used in CD mass screening and its 
      performance can be enhanced by sequential testing for EMA or HLA-DQ genotyping.
FAU - Sandstrom, Olof
AU  - Sandstrom O
AD  - *Department of Public Health and Clinical Medicine, Epidemiology and Global 
      Health daggerDepartment of Clinical Sciences, Pediatrics, Umea University, Umea 
      double daggerDepartment of Clinical Sciences, Pediatrics, Skanes University Hospital, Lund 
      University, Lund  section signPediatric Clinic, Norrkoping Hospital, Norrkoping, Sweden.
FAU - Rosen, Anna
AU  - Rosen A
FAU - Lagerqvist, Carina
AU  - Lagerqvist C
FAU - Carlsson, Annelie
AU  - Carlsson A
FAU - Hernell, Olle
AU  - Hernell O
FAU - Hogberg, Lotta
AU  - Hogberg L
FAU - Ivarsson, Anneli
AU  - Ivarsson A
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PL  - United States
TA  - J Pediatr Gastroenterol Nutr
JT  - Journal of pediatric gastroenterology and nutrition
JID - 8211545
RN  - 0 (Autoantibodies)
RN  - 0 (Biomarkers)
RN  - 0 (HLA-DQ Antigens)
RN  - 0 (HLA-DQ2 antigen)
RN  - 0 (HLA-DQ8 antigen)
RN  - 0 (Immunoglobulin A)
RN  - 8002-80-0 (Glutens)
RN  - EC 2.3.2.13 (Transglutaminases)
SB  - IM
CIN - J Pediatr Gastroenterol Nutr. 2013 Oct;57(4):414-5. PMID: 24084371
MH  - Area Under Curve
MH  - Autoantibodies/*blood
MH  - Biomarkers/blood
MH  - Biopsy
MH  - Celiac Disease/blood/*diagnosis/immunology
MH  - Child
MH  - Connective Tissue/immunology
MH  - Female
MH  - Genotype
MH  - Glutens/immunology
MH  - HLA-DQ Antigens/*blood/genetics
MH  - Humans
MH  - Immunoglobulin A/*blood
MH  - Intestine, Small
MH  - Leukocytes/immunology
MH  - Male
MH  - Mass Screening/*methods
MH  - ROC Curve
MH  - Reference Values
MH  - Sensitivity and Specificity
MH  - Sweden
MH  - Transglutaminases/*immunology
EDAT- 2013/06/21 06:00
MHDA- 2014/04/20 06:00
CRDT- 2013/06/21 06:00
PHST- 2013/06/21 06:00 [entrez]
PHST- 2013/06/21 06:00 [pubmed]
PHST- 2014/04/20 06:00 [medline]
AID - 10.1097/MPG.0b013e31829ef65d [doi]
PST - ppublish
SO  - J Pediatr Gastroenterol Nutr. 2013 Oct;57(4):472-6. doi: 
      10.1097/MPG.0b013e31829ef65d.