Diagnostic Value of Persistently Low Positive TGA-IgA Titers
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Researchers aimed to identify the diagnostic value of persistently low positive TGA-IgA titers in predicting CD in children. While the algorithm to diagnose celiac disease (CD) in children with elevated anti-transglutaminase IgA (TGA-IgA) titers (more than 10 times upper limit of normal, ULN) is well defined, the management of children with low TGA-IgA values represents a clinical challenge.

Researchers retrospectively analyzed children with symptoms or signs of CD, not eligible for a no-biopsy approach. Children with at least 2 TGA-IgA measurements, endomysial antibody (EMA) assessment and esophagogastroduodenoscopy with biopsies were included. TGA-IgA values were provided as multiples of ULN. Patients were classified in groups according to median TGA-IgA values: A (TGA-IgA more than 1 less than 5 × ULN; defined as “low-positive”), B (TGA-IgA more than 5 less than 10 × ULN; “moderate-positive”), and C (controls).

Results:
--Data of 281 children were analyzed. Of 162 children in group A, CD was diagnosed in 142 whereas normal duodenal mucosa was found in 20.

--In group B, all 62 children received a CD diagnosis.

--Group C included 57 controls. EMA were undetectable in 31 of mucosal atrophy cases.

--On the receiver-operating characteristic curve (area under the curve = 0.910), a mean value of 1.7 ULN showed a sensitivity of 81.4% and specificity of 81.8% to predict mucosal damage.

Finally, TGA-IgA values that are consistently low or moderate (less than 5 ULN or less than 10 ULN) are strong predictors of a CD diagnosis. Regardless of EMA status, symptomatic children with persistently low positive TGA-IgA titers should have an esophagogastroduodenoscopy.

Source: https://journals.lww.com/jpgn/Abstract/2021/05000/Diagnostic_Value_of_Persistently_Low_Positive.16.aspx
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