Correlation of Anti-Tissue Transglutaminase Antibodies With the Mucosal Changes and IgA Status of Children With Celiac Disease

Objectives: The objective of this study was to assess the association between serological markers and changes of the intestinal mucosa in children with celiac disease (CD). Methods: Clinical data from CD patients under 15 years old were collected from the participating centers in an on-line multicenter nationwide observational Spanish registry called REPAC-2 (2011-2017). Correlation between anti-tissue transglutaminase antibodies (t-TGA) levels and other variables. including mucosal damage and clinical findings (symptoms. age. and gender), was assessed. Results: A total of 2955 of 4838 patients had t-TGA and a small bowel biopsy (5313) performed for CD diagnosis. A total of 1931 (66.2%) patients with normal IgA values had a Marsh 3b-c lesion and 1892 (64.9%) had t-TGA Immunoglobulin A (IgA) >= 10 times upper limit of normal (ULN). There is a statistically significant association between t-TGA IgA levels and the degree of mucosa] damage (P < 0.001), the higher the t-TGA IgA levels the more severe the mucosal damage. Those patients who reported symptoms had more severe mucosal damage (P = 0.001). On the contrary. there was a negative association between age and changes of the intestinal mucosa (P < 0.001). No association was found with gender. Regarding the IgA-deficient patients, 47.4% (18 cases) had t-TGA Immunoglobulin A (IgA) >= 10 times ULN and a Marsh 3b-c lesion was observed in 68.4% (26 patients). No statistical rela-tion was found between t-TGA IgG levels and the changes of the intestinal mucosa, neither a relation with age, gender, or symptoms. Conclusions: There is a positive correlation between t-TGA IgA levels and the severity of changes of the intestinal mucosa. Such correlation was not found in IgA-deficient patients who had positive i-TGA IgG serology. The results in this group of patients support the European Society for Paediatric Gastroenterology, Hepatology. and Nutrition recommendations about the need of performing a SBB in IgA-deficient individuals despite high i:IGA IgG levels.

Automated summary

This study assessed the association between serological markers and changes in the intestinal mucosa in children with celiac disease. The results showed a positive correlation between t-TGA IgA levels and the severity of mucosal damage. Age was negatively associated with intestinal mucosal changes. In IgA-deficient patients, there was no correlation found between t-TGA IgG levels and intestinal mucosal changes.