Antibodies to recombinant human tissue-transglutaminase in coeliac disease: Diagnostic effectiveness and decline pattern after gluten-free diet

Objectives and study: To compare the values of gluten-related immunogenic peptides (GIP) in stool and anti-tissue transglutaminase IgA antibodies (anti-tTG IgA) in blood in children newly diagnosed with coeliac disease (CD). Methods: All children (2–15 y) newly diagnosed with CD between May 2018 and May 2020 at our clinic who complied with the inclusion criteria were invited to join the prospective study. During workup for CD, a stool sample to measure GIP was taken together with a blood sample to measure anti-tTG IgA. All newly diagnosed children were invited 4 months later for a check-up. Children and their caregivers were asked about known non-compliance with the gluten-free diet (GFD), a blood sample was taken to measure the anti-tTG IgA, and a stool sample was collected to measure GIP. Blood was evaluated for anti-tTG IgA by ELISA, and the stool was tested by quantitative Sandwich ELISA designed to detect and quantify GIP using the G12 antibody. Values of GIP and anti-tTG IgA were compared in terms of their relation to the upper limit of normal (ULN) of the particular method. Results: 29 children (18 girls) were enrolled in the study. The values of GIP in stool at the time of diagnosis were above the ULN (0.15 µg/g) in all children. Average 4.21, median 3.29, standard deviation (SD) 3.7. After the four months, all but three (89.7%) had values of GIP in the reference range. Average 0.29, median 0.12, SD 0.73. Similarly, anti-tTG IgA values were above the ULN (9.9 U/mL) at the time of diagnosis in all children. Average 164, median 195, SD 49. Although the anti-tTG IgA levels were lower at check-up in all but one child, only 10 (34.5%) showed values within the normal range, with an average of 27.9, median 12.0, and SD 38.9. All children declared strict adherence to GFD. Discussion: Using the GIP concentration in stool, adherence to GFD in our cohort of children is very good, better than that described in literature. Conclusion: Measuring GIP in stool could prove a more sensitive indicator of adherence to GFD in the early months after the diagnosis of CD when anti-tTG IgA are still elevated above the ULN due to their well-described gradual decrease after GFD initiation.

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Coeliac disease: a diverse clinical syndrome caused by intolerance of wheat, barley and rye

Proceedings of The Nutrition Society ◽

10.1079/pns2005461 ◽

2005 ◽

Vol 64 (4) ◽

pp. 434-450 ◽

Cited By ~ 44

Author(s):

Norma McGough ◽

John H. Cummings

Keyword(s):

Coeliac Disease ◽

Bone Fractures ◽

Tissue Transglutaminase ◽

Clinical Syndrome ◽

Gluten Free Diet ◽

Autoimmune Response ◽

Intestinal Biopsy ◽

Bowel Habit ◽

Jejunal Mucosa ◽

Gluten Free

Coeliac disease is a lifelong intolerance to the gluten found in wheat, barley and rye, and some patients are also sensitive to oats. The disease is genetically determined, with 10% of the first-degree relatives affected and 75% of monozygotic twins being concordant. Of the patients with coeliac disease 95% are human leucocyte antigen (HLA)-DQ2 or HLA-DQ8 positive. Characteristically, the jejunal mucosa becomes damaged by a T-cell-mediated autoimmune response that is thought to be initiated by a 33-mer peptide fragment in A2 gliadin, and patients with this disorder have raised levels of anti-endomysium and tissue transglutaminase antibodies in their blood. Coeliac disease is the major diagnosable food intolerance and, with the advent of a simple blood test for case finding, prevalence rates are thought to be approximately 1:100. Classically, the condition presented with malabsorption and failure to thrive in infancy, but this picture has now been overtaken by the much more common presentation in adults, usually with non-specific symptoms such as tiredness and anaemia, disturbance in bowel habit or following low-impact bone fractures. Small intestinal biopsy is necessary for diagnosis and shows a characteristically flat appearance with crypt hypoplasia and infiltration of the epithelium with lymphocytes. Diet is the key to management and a gluten-free diet effectively cures the condition. However, this commitment is lifelong and many aisles in the supermarket are effectively closed to individuals with coeliac disease. Compliance can be monitored by measuring antibodies in blood, which revert to negative after 6–9 months. Patients with minor symptoms, who are found incidentally to have coeliac disease, often ask whether it is necessary to adhere to the diet. Current advice is that dietary adherence is necessary to avoid the long-term complications, which are, principally, osteoporosis and small bowel lymphoma. However, risk of these complications diminishes very considerably in patients who are on a gluten-free diet.

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Coeliac disease as the cause of resistant sideropenic anaemia in children with Down's syndrome: Case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1002091p ◽

2010 ◽

Vol 138 (1-2) ◽

pp. 91-94 ◽

Cited By ~ 2

Author(s):

Momcilo Pavlovic ◽

Nedeljko Radlovic ◽

Zoran Lekovic ◽

Karolina Berenji ◽

Zorica Stojsic ◽

...

Keyword(s):

Coeliac Disease ◽

Oral Therapy ◽

Tissue Transglutaminase ◽

Down's Syndrome ◽

Down’S Syndrome ◽

Duodenal Mucosa ◽

Gluten Free Diet ◽

Gluten Free ◽

Atrioventricular Canal ◽

Related Proteins

Introduction. Coeliac disease (CD) is a permanent intolerance of gluten, i.e. of gliadin and related proteins found in the endosperm of wheat, rye and barley. It is characterized by polygenic predisposition, autoimmune nature, predominantly asymptomatic or atypical clinical course, as well as by high prevalence in patients with Down's syndrome (DS) and some other diseases. Outline of Cases. We are presenting a girl and two boys, aged 6-7 (X=6.33) years with DS and CD recognized under the feature of sideropenic anaemia resistant to oral therapy with iron. Beside mental retardation, low stature and the morphological features characteristic of DS, two patients had a congenital heart disease; one ventricular septal defect and the other atrioventricular canal. In two patients, trisomy on the 21st chromosome pair (trisomy 21) was disclosed in all cells, while one had a mosaic karyotype. All three patients had classical laboratory parameters of sideropenic anaemia: blood Hb 77-89 g/l (X=81.67), HCT 0.26-0.29% (X=0.28), MCV 69-80 fl (X=73), MCH 24.3-30 pg (X=26.77) and serum iron 2-5 ?mol/L (X=4.0). Beside anaemia and in one patient a mild isolated hypertransaminasemia (AST 67 U/l, ALT 62 U/l), other indicators of CD were not registered in any of the children. In addition, in all three patients, we also detected an increased level of antibodies to tissue transglutaminase (atTG) of IgA class (45-88 U/l) so that we performed endoscopic enterobiopsy in order to reliably confirm the diagnosis of CD. In all three patients, the pathohistological finding of the duodenal mucosa specimen showed mild to moderate destructive enteropathy associated with high intraepithelial lymphocyte infiltration, cryptic hyperplasia and lympho-plasmocytic infiltration of the stroma. In all three patients, the treatment with a strict gluten-free diet and iron therapy applied orally for 3-4 months resulted in blood count normalization and the correction of sideropenia. Serum level of the atTG-IgA, repeated after a 12-month diet, was also normal. Conclusion. CD should be taken into consideration in all cases of sideropenic anaemia resistant to iron oral therapy in children with DS. The diagnosis of CD implicates corresponding pathohistological confirmation, while the treatment of sideropenic anaemia and its complications, beside iron preparations, also requires compliance with a gluten-free diet.

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Reduction of tissue transglutaminase autoantibody levels by gluten-free diet is associated with changes in subsets of peripheral blood lymphocytes in children with newly diagnosed coeliac disease

Clinical & Experimental Immunology ◽

10.1111/j.1365-2249.2006.03036.x ◽

2006 ◽

Vol 144 (1) ◽

pp. 67-75 ◽

Cited By ~ 21

Author(s):

D. Agardh ◽

K. Lynch ◽

C. Brundin ◽

S.-A. Ivarsson ◽

A. Lernmark ◽

...

Keyword(s):

Coeliac Disease ◽

Peripheral Blood ◽

Tissue Transglutaminase ◽

Peripheral Blood Lymphocytes ◽

Gluten Free Diet ◽

Gluten Free ◽

Newly Diagnosed ◽

Blood Lymphocytes

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Diagnosis and management of coeliac disease in children

British Journal of Nursing ◽

10.12968/bjon.2021.30.13.s6 ◽

2021 ◽

Vol 30 (13) ◽

pp. S6-S10

Author(s):

Siba Prosad Paul ◽

Abeeran Ranjan ◽

Gillian Bremner ◽

Peter Michael Gillett

Keyword(s):

Positive Result ◽

Coeliac Disease ◽

European Society ◽

Tissue Transglutaminase ◽

Gluten Free Diet ◽

Gluten Free ◽

Serological Screening ◽

Strict Adherence ◽

Clinical Support ◽

Diagnostic Pathways

Coeliac disease (CD) is an autoimmune gluten-dependent condition with a prevalence of 1% in the population, if screened. However, approximately only a third of children with CD are diagnosed. When CD is suspected, serological screening with anti-tissue transglutaminase titres should be performed. Children with a positive result should be referred to a specialist in CD for confirmation of the diagnosis. The European Society for Paediatric Gastroenterology Hepatology and Nutrition revised their diagnostic guidance for CD in 2020 and this article discusses the current diagnostic pathways. Lifelong strict adherence to a gluten-free diet is necessary to prevent complications. Nurses and specialist paediatric dietitians have an important role in recognising and diagnosing CD early, as well as offering ongoing dietary and clinical support.

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Micronutrient deficiencies in children with coeliac disease; a double-edged sword of both untreated disease and treatment with gluten-free diet

Clinical Nutrition ◽

10.1016/j.clnu.2021.03.006 ◽

2021 ◽

Author(s):

Lorcan McGrogan ◽

Mary Mackinder ◽

Fiona Stefanowicz ◽

Maria Aroutiounova ◽

Anthony Catchpole ◽

...

Keyword(s):

Coeliac Disease ◽

Gluten Free Diet ◽

Gluten Free ◽

Micronutrient Deficiencies

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Wait-and-See Approach or Gluten-Free Diet Administration—The Rational Management of Potential Coeliac Disease

Nutrients ◽

10.3390/nu13030947 ◽

2021 ◽

Vol 13 (3) ◽

pp. 947

Author(s):

Anna Szaflarska-Popławska

Keyword(s):

Small Intestine ◽

Celiac Disease ◽

Prognostic Factors ◽

Coeliac Disease ◽

Gluten Free Diet ◽

Gluten Free ◽

Individual Basis ◽

Therapeutic Decisions ◽

Rational Management ◽

Wait And See

Potential celiac disease (PCD) is a heterogeneous disease; only some patients develop full celiac disease (CD), characterised by advanced atrophic changes in the small intestine. Few accurate prognostic factors exist for the progression of PCD; therefore, therapeutic decisions should be made on an individual basis in each case. Patients with clinical gastroenterological or parenteral symptoms often benefit from a gluten-free diet, and those left on a diet containing gluten should receive clinical, serological and histopathological supervision.

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The impact of symptoms on quality of life before and after diagnosis of coeliac disease: the results from a Polish population survey and comparison with the results from the United Kingdom

BMC Gastroenterology ◽

10.1186/s12876-021-01673-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Emilia Majsiak ◽

Magdalena Choina ◽

Dominik Golicki ◽

Alastair M. Gray ◽

Bożena Cukrowska

Keyword(s):

Quality Of Life ◽

United Kingdom ◽

Coeliac Disease ◽

Gluten Free Diet ◽

Gluten Free ◽

The United Kingdom ◽

Before And After ◽

The Mean ◽

The Uk

Abstract Background Coeliac disease (CD) is characterised by diverse clinical symptoms, which may cause diagnostic problems and reduce the patients’ quality of life. A study conducted in the United Kingdom (UK) revealed that the mean time between the onset of coeliac symptoms and being diagnosed was above 13 years. This study aimed to analyse the diagnostic process of CD in Poland and evaluate the quality of life of patients before and after CD diagnosis. In addition, results were compared to the results of the original study conducted in the UK. Methods The study included 2500 members of the Polish Coeliac Society. The patients were asked to complete a questionnaire containing questions on socio-demographic factors, clinical aspects and quality of life, using the EQ-5D questionnaire. Questionnaires received from 796 respondents were included in the final analysis. Results The most common symptoms reported by respondents were bloating (75%), abdominal pain (72%), chronic fatigue (63%) and anaemia (58%). Anaemia was the most persistent symptom, with mean duration prior to CD diagnosis of 9.2 years, whereas diarrhoea was observed for the shortest period (4.7 years). The mean duration of any symptom before CD diagnosis was 7.3 years, compared to 13.2 years in the UK. CD diagnosis and the introduction of a gluten-free diet substantially improved the quality of life in each of the five EQ-5D-5L health dimensions: pain and discomfort, anxiety and depression, usual activities, self-care and mobility (p < 0.001), the EQ-Index by 0.149 (SD 0.23) and the EQ-VAS by 30.4 (SD 28.3) points. Conclusions Duration of symptoms prior to the diagnosis of CD in Poland, although shorter than in the UK, was long with an average of 7.3 years from first CD symptoms. Faster CD diagnosis after the onset of symptoms in Polish respondents may be related to a higher percentage of children in the Polish sample. Introduction of a gluten-free diet improves coeliac patients’ quality of life. These results suggest that doctors should be made more aware of CD and its symptoms across all age groups.

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