Antibodies Against Deamidated Gliadin Peptides and Tissue Transglutaminase for Diagnosis of Pediatric Celiac Disease - Diagnostic Performance and Cost in Clinical Practice.
Author
Summary, in English
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.
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.
Publishing year
2012-06-19
Language
English
Publication/Series
Journal of Pediatric Gastroenterology and Nutrition - Jpgn
Links
Document type
Journal article
Publisher
Lippincott Williams & Wilkins
Topic
- Pediatrics
Status
Published
ISBN/ISSN/Other
- ISSN: 1536-4801