SEROLOGICAL VERUS HISTOLOGICAL DIAGNOSIS IN PEDIATRIC CELIAC DISEASE: IS THERE A NEED FOR SMALL BOWEL BIOPSY?
Objective: To evaluate the role of tissue transglutaminase IgA antibody (TTG IgA Ab) in diagnosis of pediatric celiac disease (CD) taking small bowel biopsy as gold standard.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Pediatric Gastroenterology, the Children’s Hospital & the Institute of Child Health, Lahore, from Jan 2018 to Jun 2018.
Methodology: Sixty patients aged 2-18 years, with suspicion of CD, having at least 3 presenting features from chronic diarrhea, malnutrition, short stature, anemia, abdominal distention and digital clubbing, were included. TTG IgA Ab titre, small bowel biopsy (SBB) and histopathology were done in all cases.
Results: Of the 60 participants, 22 (36.7%) were male and 38 (63.3%) were female with mean age of 6.56 ± 3.78 years. The calculated sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy are 94.1%, 96.1%, 96.9%, 92.5% & 95% respectively. TTG IgA Ab value more than 90 U/ml corresponds to Marsh 3b or higher grade lesion with 94.73% positive predictive value.
Conclusion: There is a strong correlation between TTG titres and degree of duodenal damage in patients suspected of CD. Biopsy can be avoided when TTG level is more than 9 times the manufacturer’s cut off value.