Diagnostic Efficacy of Anti-Tissue Transglutaminase IgA Levels Exceeding Five Times The Upper Limit of Normal In Pediatric Celiac Disease At A Tertiary Care Centre

Saba  Idrees; Farooq  Ikram; Afnan  Shamraiz; Raazia  Nawaz; Bilal .; Husna  Khan

doi:10.51253/pafmj.v75i3.10523

Authors

Saba Idrees Department of Paediatric Gastroenterology, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Farooq Ikram Department of Paediatric Gastroenterology, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Afnan Shamraiz Department of Paediatric Gastroenterology, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Raazia Nawaz Department of Paediatric Gastroenterology, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Bilal . Department of Paediatric Gastroenterology, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Husna Khan Department of Paediatric Gastroenterology, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i3.10523

Keywords:

Celiac disease, Duodenal Biopsy, Histopathology, Paediatrics, Serology

Abstract

Objective: To determine the diagnostic efficacy of anti-tissue transglutaminase IgA (tTG-IgA) levels exceeding 5 times the upper limit of normal (ULN) in children with celiac disease referred to a tertiary care centre.

Study Design: Cross-sectional validation study.

Place and Duration of Study: Combined Military Hospital (CMH), Rawalpindi, Pakistan, from Feb 2022 to May 2023 for 15 months.

Methodology: Children ≤ 16 years presenting in Paediatric Outpatient Department and admitted to Paediatric ward of Combined Military Hospital, Rawalpindi, Pakistan, with clinical features of chronic diarrhoea, abdominal distension, failure to thrive, pain in abdomen, vomiting, constipation, and pallor were included in the study. Demographic details, age, gender, weight, and height were recorded. Abdominal distension and anaemia were recorded clinically. Blood samples were withdrawn for haemoglobin and anti-tTG IgA titre. Upper gastrointestinal endoscopy was performed, and duodenal biopsy samples were sent for histopathology to pathologist.

Results: Total number of patients was 60. There were 25 (41.6%) males and 35 (58.3%) females. The Median age was 4.7 (7.00 – 3.00) years. Out of 60 patients, 45(75%) had celiac disease. Sensitivity of anti-tTG IgA more than 5 times upper limit of normal was 77.7%, specificity was 60%, positive predictive value was 85.3% and negative predictive value was 47.3% for diagnosing Celiac disease.

Conclusion: Anti-tTG IgA values > 50IU/ml have an 85.3% positive predictive value for diagnosis of celiac disease. Hence such patients can be exempted from invasive endoscopic procedure and histological confirmation.

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