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Children with coeliac disease and anti-tissue transglutaminase antibodies

Journal of Pediatric Gastroenterology and Nutrition
REPAC-2 registry
Physician’s Weekly – 16/01/2023 – For a study, researchers sought to examine the relationship between serological markers and alterations in the intestinal mucosa in kids with coeliac disease (CD).

The participating sites in the online multicentre countrywide observational Spanish registry known as REPAC-2 (2011–2017) provided clinical data on CD patients under the age of 15 for the registry. Anti-tissue transglutaminase antibodies (t-TGA) levels and other factors, such as mucosal damage and clinical findings (symptoms, age, and gender), were evaluated for correlation.

A small bowel biopsy (SBB) and t-TGA were conducted for the CD diagnosis on 2,955 of 4,838 individuals. Marsh 3b-c lesions were present in 1,931 (66.2%) individuals with normal IgA values overall, and 1,892 (64.9%) had t-TGA Immunoglobulin A (IgA) levels ≥10 times the upper limit of normal (ULN).  The severity of mucosal damage and t-TGA IgA levels were statistically significantly correlated (P< 0.001); the greater the t-TGA IgA level, the more severe the mucosal damage. Patients who exhibited symptoms (P = 0.001) had a more severe mucosal injury. On the other hand, there was a negative correlation (P< 0.001) between aging and alterations in the intestinal mucosa. There was no connection to gender. Regarding the IgA-deficient individuals, t-TGA Immunoglobulin A (IgA) ≥ 10 times ULN was found in 47.4% (18 instances) of them, and a Marsh 3b-c lesion was found in 68.4% of them (26 patients). The alterations in the intestinal mucosa, and t-TGA IgG were not statistically related, nor were age, gender, or symptoms.

The severity of alterations to the intestinal mucosa was positively correlated with t-TGA IgA levels. Patients with IgA deficiency with positive t-TGA IgG serology did not exhibit the connection. The findings in the patient group were consistent with the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition’s recommendations that SBBs be performed on IgA-deficient people even when their t-TGA IgG levels were high.

Source: J Pediatr Gastroenterol Nutr. 2022;75(6):743-748. DOI: 10.1097/MPG.0000000000003620

Originally Published By Physician’s Weekly. Reused by Medicom Medical Publishers with permission.

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