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Correlation of Anti-Tissue Transglutaminase Antibodies With the Mucosal Changes and IgA Status of Children With Celiac Disease

2022; Lippincott Williams & Wilkins; Volume: 75; Issue: 6 Linguagem: Inglês

10.1097/mpg.0000000000003620

1536-4801

Ester Donat, María Roca, Gemma Castillejo, Félix Sánchez‐Valverde, José Ignacio García-Burriel, Eva Martínez‐Ojinaga, Francisco Javier Eizaguirre, Josefa Barrio Torres, M L Cilleruelo, David Pérez Solís, Carlos Ochoa Sangrador, Raquel Vecino‐López, Ma del Carmen Miranda-Cid, Salvador García-Calatayud, Ricardo Torres, Mercedes Juste, H Armas, Patricia Barros-García, Rosaura Leis, Rosa Solaguren, José Carlos Rosas Gómez de Salazar, Ruth García‐Romero, Luís Ortigosa, Luis Peña Quintana, Pedro Urruzuno, Pilar Codoñer‐Franch, Zuriñe Garcia-Casales, M. Masiques, Gonzalo Galicia‐Poblet, Elena Crehuá‐Gaudiza, Elena Balmaseda, Javier Rubio-Santiago, Isabel Polanco-Allué, Enriqueta Román‐Riechmann, Carmen Ribes‐Koninckx,

Gastrointestinal disorders and treatments

Objectives: The objective of this study was to assess the association between serological markers and changes of the intestinal mucosa in children with celiac disease (CD). Methods: Clinical data from CD patients under 15 years old were collected from the participating centers in an on-line multicenter nationwide observational Spanish registry called REPAC-2 (2011–2017). Correlation between anti-tissue transglutaminase antibodies (t-TGA) levels and other variables, including mucosal damage and clinical findings (symptoms, age, and gender), was assessed. Results: A total of 2955 of 4838 patients had t-TGA and a small bowel biopsy (SBB) performed for CD diagnosis. A total of 1931 (66.2%) patients with normal IgA values had a Marsh 3b-c lesion and 1892 (64.9%) had t-TGA Immunoglobulin A (IgA) ≥ 10 times upper limit of normal (ULN). There is a statistically significant association between t-TGA IgA levels and the degree of mucosal damage ( P < 0.001), the higher the t-TGA IgA levels the more severe the mucosal damage. Those patients who reported symptoms had more severe mucosal damage ( P = 0.001). On the contrary, there was a negative association between age and changes of the intestinal mucosa ( P < 0.001). No association was found with gender. Regarding the IgA-deficient patients, 47.4% (18 cases) had t-TGA Immunoglobulin A (IgA) ≥ 10 times ULN and a Marsh 3b-c lesion was observed in 68.4% (26 patients). No statistical relation was found between t-TGA IgG levels and the changes of the intestinal mucosa, neither a relation with age, gender, or symptoms. Conclusions: There is a positive correlation between t-TGA IgA levels and the severity of changes of the intestinal mucosa. Such correlation was not found in IgA-deficient patients who had positive t-TGA IgG serology. The results in this group of patients support the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition recommendations about the need of performing a SBB in IgA-deficient individuals despite high t-TGA IgG levels.