Celiac Disease is a very common, genetic autoimmune digestive disease that affects 1 in 100 people and which damages the small intestine. “CD may develop any time after wheat or other gluten-containing foods are introduced into the diet, typically after 6-9 months of age”.
Some children present clinically early, others only after years of exposure. Gastrointestinal symptoms vary widely and depend on age at presentation (e.g., Infants: vomiting, bloating, diarrhea and poor growth. School-aged children: Abdominal pain/distention, diarrhea or constipation, weight gain/loss. Older children/teens: short stature, delayed puberty, chronic fatigue, arthralgia and/or mood disorders, etc.). Screening diagnosis is made by finding antibodies to bowel in the blood (Immunoglobulin A – IgA; IgA anti-tissue transglutaminase – Anti-tTG; and IgA anti-endomysial antibodies – IgA-EmA) and intestinal endoscopy/biopsy for histology and genetic testing (HLA-DQ2 and DQ8). In addition to the index child other family members (first-degree relatives) should be tested for CD.
Studies examined the relationship between TGA-IgA antibodies (Anti-tTG IgA) and the degree of intestinal enteropathy as well as whether TGA-IgA titres levels correlate sufficiently to be able to have a “no-biopsy” approach are few.
A study of 34 previously diagnosed CD children which examined sensitivity and specificity of blood TGA-IgA titre >10× the upper limit of normal (ULN) vs. villous atrophy on biopsy, indicates that at that titre level CD is correctly diagnosed in 100% children.
