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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

Online
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1437-4331
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Volume 53, Issue 10

Issues

Combining antibody tests and taking into account antibody levels improves serologic diagnosis of celiac disease

Matthijs Oyaert / Pieter Vermeersch
  • Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
  • Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Leuven, Belgium
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Gert De Hertogh / Martin Hiele / Nathalie Vandeputte / Ilse Hoffman / Xavier Bossuyt
  • Corresponding author
  • Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
  • Laboratory Medicine, Immunology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
  • Department of Microbiology and Immunology, KU Leuven – University of Leuven, Leuven, Belgium
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2015-02-19 | DOI: https://doi.org/10.1515/cclm-2013-1099

Abstract

Background: The European Society for Pediatric Gastroenterology and Nutrition states that if IgA anti-tissue transglutaminase (tTG) exceeds 10 times the upper limit of normal (ULN), there is the possibility to diagnose celiac disease (CD) without duodenal biopsy, if supported by anti-endomysium testing and human leukocyte antigen (HLA) typing. We aimed to evaluate whether combining IgA tTG and IgG anti-deamidated gliadin peptide (DGP) antibody testing and taking into account the antibody levels improves clinical interpretation.

Methods: We calculated likelihood ratios for various test result combinations using data obtained from newly diagnosed CD patients (n=156) [13 children <2 years, 45 children between 2 and 16 years, and 98 adults (>16 years)] and 974 disease controls. All patients and controls underwent duodenal biopsy. IgA anti-tTG and IgG anti-DGP assays were from Thermo Fisher and Inova.

Results: Likelihood ratios for CD markedly increased with double positivity and increasing antibody levels of IgA anti-tTG and IgG anti-DGP. Patients with double positivity and high antibody levels (>3 times, >10 times ULN) had a high probability for having CD (likelihood ratio ≥649 for >3 times ULN and ∞ for >10 times ULN). The fraction of CD patients with double positivity and high antibody levels was 59%–67% (depending on the assay) for >3 ULN and 33%–36% (depending on the assay) for >10 ULN, respectively. This fraction was significantly higher in children with CD than in adults.

Conclusions: Combining IgG anti-DGP with IgA anti-tTG and defining thresholds for antibody levels improves the serologic diagnosis of CD.

Keywords: anti-deamidated gliadin; anti-tissue transglutaminase; celiac disease; likelihood ratio

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About the article

Corresponding author: Xavier Bossuyt, MD, PhD, Laboratory Medicine, Immunology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium, Phone: +32 16 347009, Fax: +32 16 347931, E-mail: ; Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium ; and Department of Microbiology and Immunology, KU Leuven – University of Leuven, Leuven, Belgium


Received: 2013-12-21

Accepted: 2015-01-09

Published Online: 2015-02-19

Published in Print: 2015-09-01


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 53, Issue 10, Pages 1537–1546, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2013-1099.

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