Diagnostic value of serological markers for celiac disease in children

Introduction. Serologic tests are the main tool to screen for celiac disease. The serologic tests for tissue transglutaminase (tTG-IgA) antibodies combined with the assessment of the total serum IgA concentration is recommended as a primary test. Other serological markers, in particular IgA and/or IgG antibodies against deamidated gliadin peptides (DGP-IgG/IgA) and native gliadin (AGA-IgA/IgG), are not recommended for use in diagnosing celiac disease in immunocompetent patients.

Aim. To determine the diagnostic value of serological markers during the initial examination for celiac disease in children.

Materials and methods. The sensitivity, specificity, positive and negative predictive value of tTG-IgA/IgG, DPG-IgA/IgG, AGA-IgA/IgG were calculated for a group of 1247 children.

Results. Celiac disease was diagnosed in 101 patients of the study group. Tissue transglutaminase IgA antibodies demonstrated the highest sensitivity, specificity, positive and negative predictive values of 98.02, 99.48, 94.29 and 99.82%, respectively. DPG-IgA/IgG, AGA-IgA were inferior in sensitivity and specificity to tTG-IgA, the positive predictive value of DGP-IgG and AGA-IgA was 34.62 and 34.21%, respectively. AGA-IgG showed the worst specificity (40.3%) and positive predictive values (12.41%).

Discussion The low predictive value of the positive results of AGA IgA and DPG IgG determines the extremely high percentage of false-positive results for these tests. In none of the cases of an isolated elevation in AGA and DPG antibodies the diagnosis of celiac disease was confirmed, if tissue transglutaminase IgA antibody concentrations were normal.

Conclusion. The results of our study are fully consistent with the position of modern clinical guidelines, demonstrating the maximum diagnostic value of tissue transglutaminase IgA antibody during examination for celiac disease. Other antibodies are not recommended for use in the screening process to avoid unnecessary referrals of patients for endoscopic examination and to reduce healthcare costs.

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