Serology as a predictor of mucosal recovery in children with celiac disease on a gluten-free diet
OA Version
Citation
Abstract
BACKGROUND: Research continues to be done to assess if serology markers are predictors of mucosal recovery in individuals with celiac disease (CD), eliminating the need for additional biopsies after treatment with a gluten-free diet (GFD). Aim: The objective of this study is to determine if the anti-deamidated gliadin protein (DGP) immunoglobulin G (IgG) serology test can predict mucosal recovery at the time of a repeat endoscopy with duodenal biopsies in pediatric subjects.
METHODS: A total of 176 subjects were included in this study, ages 2 to 21 years old, diagnosed with CD, and having undergone diagnostic and repeat duodenal biopsies through esophagogastroduodenoscopy (EGD). Subjects provided blood, urine, and tissue samples as well as completed questionnaires. ELISA QUANTA Lite Rh-tTG IgA on the BioFlash platform was used for the determination of IgG antibodies against DGP epitopes in subjects’ serum.
RESULTS: Of the 176 subjects included, 23 subjects (13%) had persistent enteropathy (PE) defined as a Marsh score of 3. DGP-IgG was elevated in 7 out of 23 (30%) of these subjects. 153 CD subjects were in remission, defined as having Marsh scores of 0 through 2 and five positive DGP-IgG values (33%). Overall, the positive predictive value (PPV) of DGP-IgG for mucosal damage and a positive DGP-IgG value was 58% and the negative predictive value (NPV) was 91%. There was a statistically significant elevation in DGP-IgG serum values for subjects with a Marsh score of 2 and 3 compared to subjects with a Marsh score of 0 (p<0.05). Additionally, there was a statistically significant difference in DGP-IgG serum values between those with CD in remission vs. those with persistent enteropathy (p=0.02). Lastly, DGP-IgG values at diagnosis versus at follow-up were compared for 24 subjects, with a statistically significant drop in DGP-IgG values for the remission group at follow-up (p<0.01).
CONCLUSION: Subjects with PE had elevated DGP-IgG levels at follow-up compared to the remission group. DGP-IgG values were relatively reliable indicators of mucosal healing for subjects in remission, although they were not completely predictive of mucosal damage in those with PE at the time of a repeat EGD. These findings suggest that DGP-IgG is a useful serology test to use at the time of follow-up and that additional pairings or varieties of tests along with DGP-IgG may be very useful in predicting mucosal recovery over time on a GFD. Keywords: celiac, serology, pediatric, duodenal, remission, anti-DGP (IgG)
Description
2024