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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Gastroenterology 1/2014

Follow-up of pediatric celiac disease: value of antibodies in predicting mucosal healing, a prospective cohort study

Zeitschrift:
BMC Gastroenterology > Ausgabe 1/2014
Autoren:
Edith Vécsei, Stephanie Steinwendner, Hubert Kogler, Albina Innerhofer, Karin Hammer, Oskar A Haas, Gabriele Amann, Andreas Chott, Harald Vogelsang, Regine Schoenlechner, Wolfgang Huf, Andreas Vécsei
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-230X-14-28) contains supplementary material, which is available to authorized users.
Edith Vécsei, Stephanie Steinwendner contributed equally to this work.

Competing interests

The authors disclose the following: Drs. Edith Vécsei, Stephanie Steinwendner, Hubert Kogler, Albina Innerhofer, Karin Hammer, Oskar A. Haas, Gabriele Amann, Andreas Chott, Harald Vogelsang, Regine Schoenlechner, and Wolfgang Huf have no financial interests to disclose. Dr. Andreas Vécsei has served as a consultant and scientific advisor for Dr. Schär GmbH/Srl, Burgstall, BZ, Italy.
The study was partially supported by Dr. Schär GmbH/Srl, Burgstall, BZ, Italy, and the St. Anna Fund, Vienna, Austria. Antibody kits were supplied free of charge by Inova Diagnostics, Inc., Werfen Group. The study sponsors were not involved in the study design, in the collection, analysis, interpretation of data and in writing of the report.

Authors’ contributions

EV, SS, HK and AV jointly wrote the first draft of the manuscript. Furthermore, EV developed the study design, the concept and the statistical analysis plan, participated in data collection, interpreted the data and did the statistical analysis and revised the paper; SS developed the study design, the concept and the statistical analysis plan, participated in data collection and entry into the data base, analyzed and interpreted the data; HK cleaned and interpreted the data and participated in statistical analysis and revised the paper and the tables; AI was responsible for the data collection, entry in the database and clinical care of the study patients, critically revised the manuscript for important intellectual content; KH was performing the endoscopies, participated in data collection, was responsible for the clinical care of the study patients, revised the draft paper; OAH was responsible for the serological tests, revised the draft paper; GA and AC reviewed the pathological slides, participated in data collection and revised the draft paper; HV was responsible for the results of the intestinal permeability test and critically revised the manuscript for important intellectual content; RS participated in data collection and revised the paper; WH did the statistical analysis, drafted the figures and critically revised the manuscript for important intellectual content; AV developed the study design, the concept and the statistical analysis plan, obtained the funding, monitored data collection, interpreted the data and did the statistical analysis, drafted and revised the paper and supervised the study. All authors read and approved the final manuscript.

Abstract

Background

In diagnosing celiac disease (CD), serological tests are highly valuable. However, their role in following up children with CD after prescription of a gluten-free diet is unclear. This study aimed to compare the performance of antibody tests in predicting small-intestinal mucosal status in diagnosis vs. follow-up of pediatric CD.

Methods

We conducted a prospective cohort study at a tertiary-care center. 148 children underwent esophohagogastroduodenoscopy with biopsies either for symptoms ± positive CD antibodies (group A; n = 95) or following up CD diagnosed ≥ 1 year before study enrollment (group B; n = 53). Using biopsy (Marsh ≥ 2) as the criterion standard, areas under ROC curves (AUCs) and likelihood-ratios were calculated to estimate the performance of antibody tests against tissue transglutaminase (TG2), deamidated gliadin peptide (DGP) and endomysium (EMA).

Results

AUCs were higher when tests were used for CD diagnosis vs. follow-up: 1 vs. 0.86 (P = 0.100) for TG2-IgA, 0.85 vs. 0.74 (P = 0.421) for TG2-IgG, 0.97 vs. 0.61 (P = 0.004) for DPG-IgA, and 0.99 vs. 0.88 (P = 0.053) for DPG-IgG, respectively. Empirical power was 85% for the DPG-IgA comparison, and on average 33% (range 13–43) for the non-significant comparisons. Among group B children, 88.7% showed mucosal healing (median 2.2 years after primary diagnosis). Only the negative likelihood-ratio of EMA was low enough (0.097) to effectively rule out persistent mucosal injury. However, out of 12 EMA-positive children with mucosal healing, 9 subsequently turned EMA-negative.

Conclusions

Among the CD antibodies examined, negative EMA most reliably predict mucosal healing. In general, however, antibody tests, especially DPG-IgA, are of limited value in predicting the mucosal status in the early years post-diagnosis but may be sufficient after a longer period of time.
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