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Antibodies Against Deamidated Gliadin Peptides and Tissue Transglutaminase for Diagnosis of Pediatric Celiac Disease - Diagnostic Performance and Cost in Clinical Practice.

Olen, Ola; Gudjónsdóttir, Audur H; Browaldh, Lars; Hessami, Mozaffar; Elvin, Kerstin; Liedberg, Ann-Sofie LU ; Neovius, Martin and Grahnquist, Lena (2012) In Journal of Pediatric Gastroenterology and Nutrition - Jpgn
Abstract
OBJECTIVES:

To evaluate diagnostic performance and actual costs in clinical practice of IgG/IgA deamidated gliadin peptide antibodies (DGP) as a complement to IgA antibodies against tissue transglutaminase (tTG) for the diagnosis of pediatric celiac disease (CD).



PATIENTS AND METHODS:

All consecutive patients <18 years tested for tTG and/or DGP and who underwent duodenal biopsy because of suspected CD in Stockholm and Gothenburg, Sweden, 2008-2010 were included. Medical records were reviewed.



RESULTS:

Of 537 children who underwent duodenal biopsy, 278(52%) had CD. 71(13%) were <2 years and 13(4%) had IgA deficiency. Sensitivity and specificity for tTG was 94% and 86%... (More)
OBJECTIVES:

To evaluate diagnostic performance and actual costs in clinical practice of IgG/IgA deamidated gliadin peptide antibodies (DGP) as a complement to IgA antibodies against tissue transglutaminase (tTG) for the diagnosis of pediatric celiac disease (CD).



PATIENTS AND METHODS:

All consecutive patients <18 years tested for tTG and/or DGP and who underwent duodenal biopsy because of suspected CD in Stockholm and Gothenburg, Sweden, 2008-2010 were included. Medical records were reviewed.



RESULTS:

Of 537 children who underwent duodenal biopsy, 278(52%) had CD. 71(13%) were <2 years and 13(4%) had IgA deficiency. Sensitivity and specificity for tTG was 94% and 86% respectively. Corresponding values for DGP was 91% and 26%. Positive predictive values (PPV) were 88% for tTG and 51% for DGP. There were 148 children who were tTG negative and DGP positive, of which only 5%(8/148) had villous atrophy. Among children <2 years with normal IgA, PPV was 96%(25/26) for tTG and 48%(24/50) for DGP. In 13 IgA deficient children 9 were DGP positive of which 4 had CD (PPV 44%). 8/278 cases of CD would possibly have been missed without DGP. The cost of adding DGP and consequently more biopsies to be able to detect 8 extra cases of CD was &OV0556;399,520 or &OV0556;49,940 per case.



CONCLUSION:

For diagnosing CD, tTG is superior to DGP, even in children <2 years. Combining tTG and DGP does not provide a better trade off between number of missed cases of CD, number of unnecessary duodenal biopsies and cost than tTG alone. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Pediatric Gastroenterology and Nutrition - Jpgn
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:22722680
  • wos:000311702500020
  • scopus:84870874372
ISSN
1536-4801
DOI
10.1097/MPG.0b013e3182645c54
language
English
LU publication?
yes
id
a57c35f2-d537-434f-bb43-0eca7665a854 (old id 2859125)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22722680?dopt=Abstract
date added to LUP
2012-07-04 19:27:01
date last changed
2017-08-20 04:37:48
@article{a57c35f2-d537-434f-bb43-0eca7665a854,
  abstract     = {OBJECTIVES:<br/><br>
To evaluate diagnostic performance and actual costs in clinical practice of IgG/IgA deamidated gliadin peptide antibodies (DGP) as a complement to IgA antibodies against tissue transglutaminase (tTG) for the diagnosis of pediatric celiac disease (CD). <br/><br>
<br/><br>
PATIENTS AND METHODS:<br/><br>
All consecutive patients &lt;18 years tested for tTG and/or DGP and who underwent duodenal biopsy because of suspected CD in Stockholm and Gothenburg, Sweden, 2008-2010 were included. Medical records were reviewed. <br/><br>
<br/><br>
RESULTS:<br/><br>
Of 537 children who underwent duodenal biopsy, 278(52%) had CD. 71(13%) were &lt;2 years and 13(4%) had IgA deficiency. Sensitivity and specificity for tTG was 94% and 86% respectively. Corresponding values for DGP was 91% and 26%. Positive predictive values (PPV) were 88% for tTG and 51% for DGP. There were 148 children who were tTG negative and DGP positive, of which only 5%(8/148) had villous atrophy. Among children &lt;2 years with normal IgA, PPV was 96%(25/26) for tTG and 48%(24/50) for DGP. In 13 IgA deficient children 9 were DGP positive of which 4 had CD (PPV 44%). 8/278 cases of CD would possibly have been missed without DGP. The cost of adding DGP and consequently more biopsies to be able to detect 8 extra cases of CD was &amp;OV0556;399,520 or &amp;OV0556;49,940 per case. <br/><br>
<br/><br>
CONCLUSION:<br/><br>
For diagnosing CD, tTG is superior to DGP, even in children &lt;2 years. Combining tTG and DGP does not provide a better trade off between number of missed cases of CD, number of unnecessary duodenal biopsies and cost than tTG alone.},
  author       = {Olen, Ola and Gudjónsdóttir, Audur H and Browaldh, Lars and Hessami, Mozaffar and Elvin, Kerstin and Liedberg, Ann-Sofie and Neovius, Martin and Grahnquist, Lena},
  issn         = {1536-4801},
  language     = {eng},
  month        = {06},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Journal of Pediatric Gastroenterology and Nutrition - Jpgn},
  title        = {Antibodies Against Deamidated Gliadin Peptides and Tissue Transglutaminase for Diagnosis of Pediatric Celiac Disease - Diagnostic Performance and Cost in Clinical Practice.},
  url          = {http://dx.doi.org/10.1097/MPG.0b013e3182645c54},
  year         = {2012},
}