PMID- 25823767
OWN - NLM
STAT- MEDLINE
DCOM- 20150720
LR  - 20220408
IS  - 1572-0241 (Electronic)
IS  - 0002-9270 (Linking)
VI  - 110
IP  - 5
DP  - 2015 May
TI  - Evaluation of the ESPGHAN Celiac Guidelines in a North American Pediatric 
      Population.
PG  - 760-7
LID - 10.1038/ajg.2015.87 [doi]
AB  - OBJECTIVES: We retrospectively examined the performance of the tissue 
      transglutaminase (TTG), endomysial antibody (EMA) tests, and the ESPGHAN 
      (European Society of Paediatric Gastroenterology, Hepatology and Nutrition) 
      nonbiopsy criteria in a pediatric population. METHODS: Consecutive celiac 
      serologies and corresponding intestinal biopsy results were obtained on children 
      <18 years old over 3.5 years. Patients were classified into three categories: 
      positive TTG, negative TTG, and IgA deficiency. RESULTS: Of the 17,505 patients 
      with celiac serology performed, 775 had a positive TTG, 574 with a negative TTG 
      were biopsied, and 25 were IgA deficient. Of the patients with a TTG >/=10 x upper 
      limit of normal (ULN), positive EMA, and symptoms, 98.2% had biopsies consistent 
      with celiac disease (CD). Four human leukocyte antigen (HLA) DQ2/DQ8-positive 
      patients who met the ESPGHAN nonbiopsy criteria did not have CD. In the group 
      with a TTG 3-10 x ULN, 75.7% EMA-positive patients and only 40% EMA-negative 
      patients had CD (P<0.001). Of those with a TTG 1-3 x ULN, 52.2% EMA-positive 
      patients vs. only 13.3% EMA-negative patients had CD (P<0.01). Of the patients 
      with bulbar and duodenal biopsies, 9.8% had CD confined only in the bulb, 
      especially those with a low titer TTG (P<0.01). CD prevalence in our cohort was 
      34.6%. Sensitivity, specificity, and positive predictive value of the TTG were 
      98.7%, 86.4%, and 79.4%, respectively. CONCLUSIONS: The TTG is a very sensitive 
      screen for CD, but positive predictive value improves with a positive EMA titer. 
      To apply the new ESPGHAN guidelines, clinicians must understand the performance 
      of their celiac serology tests.
FAU - Gidrewicz, Dominica
AU  - Gidrewicz D
AD  - Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
FAU - Potter, Kathryn
AU  - Potter K
AD  - Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
FAU - Trevenen, Cynthia L
AU  - Trevenen CL
AD  - Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, 
      Alberta, Canada.
FAU - Lyon, Martha
AU  - Lyon M
AD  - Department of Pathology and Laboratory Medicine, Saskatoon Health Region, 
      Saskatoon, Saskatchewan, Canada.
FAU - Butzner, J Decker
AU  - Butzner JD
AD  - Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150331
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
RN  - 0 (Autoantibodies)
RN  - 0 (HLA-DQ Antigens)
RN  - 0 (HLA-DQ2 antigen)
RN  - 0 (HLA-DQ8 antigen)
RN  - 0 (Immunoglobulin A)
RN  - EC 2.3.2.13 (Protein Glutamine gamma Glutamyltransferase 2)
RN  - EC 2.3.2.13 (Transglutaminases)
RN  - EC 3.6.1.- (GTP-Binding Proteins)
SB  - IM
MH  - Adolescent
MH  - Autoantibodies/*blood
MH  - Biopsy
MH  - Celiac Disease/blood/*diagnosis/pathology
MH  - Child
MH  - Child, Preschool
MH  - Diet, Gluten-Free
MH  - Duodenum/*pathology
MH  - Female
MH  - GTP-Binding Proteins
MH  - HLA-DQ Antigens/blood
MH  - Humans
MH  - Immunoglobulin A/blood
MH  - Infant
MH  - Male
MH  - *Practice Guidelines as Topic
MH  - Predictive Value of Tests
MH  - Protein Glutamine gamma Glutamyltransferase 2
MH  - Retrospective Studies
MH  - Transglutaminases/*blood
EDAT- 2015/04/01 06:00
MHDA- 2015/07/21 06:00
CRDT- 2015/04/01 06:00
PHST- 2014/11/15 00:00 [received]
PHST- 2015/02/23 00:00 [accepted]
PHST- 2015/04/01 06:00 [entrez]
PHST- 2015/04/01 06:00 [pubmed]
PHST- 2015/07/21 06:00 [medline]
AID - ajg201587 [pii]
AID - 10.1038/ajg.2015.87 [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2015 May;110(5):760-7. doi: 10.1038/ajg.2015.87. Epub 2015 
      Mar 31.