Serological Tests Assessment in Patients Suspected to have Celiac Disease Attending the Gastroenterology and Hepatology Teaching Hospital in Baghdad
Keywords:Celiac Serological Tests, Transglutaminase Antibody, Antigliadin Antibody, Deamidated Gliadin Antibody, Antiendomysial Antibody, HLA DQ2/DQ8, Marsh Classification, Duodenal Biopsy, Villous Atrophy, Chronic Diarrhea, Malabsorption, Gluten
Background: Celiac disease is characterized by small intestinal malabsorption of nutrients after the ingestion
of wheat gluten or related proteins from rye and barley, villus atrophy of the small intestinal mucosa, prompt
clinical and histologic improvement following strict adherence to a gluten-free diet, and relapse when gluten
Aim of the Study: Evaluation of patients seeking gastroenterology and hepatology teaching hospital/medical
city/Baghdad with suspected celiac disease regarding serological investigation, histological findings and
genetic testing, to determine sensitivity, specificity, positive predictive value and negative predictive value
for every test.
Patients and Method: The study is a cross sectional descriptive analytic study conducted at the teaching
hospital of gastroenterology and hepatology/Baghdad/Iraq during a period from the 1st of February 2018 to
the 1st of April 2019. After thorough history and Clinical examination patients with suspected celiac disease
were sent for serological investigation (TTG IgA and IgG), (antigliadin IgA and IgG), all patients were sent
for endoscopic examination for duodenal biopsies with subsequent histological assessment. Patients who
failed to be confirmed (positive serology and negative histology or vice versa) were sent either for HLA
genotyping or for IgG Deaminated gliadin peptide. Sensitivity & specificity were measured for each test.
Results: A total of 140 suspected celiac disease patients involved in this study. Mean age was 18.9 years
and ranged from 2 years to 60 years. Male represented 36.4% of the cases while female represented 63.6%.
Only 19 patients show positive family history of celiac disease (13.6 %). Regarding associated autoimmune
diseases, the majority (111 patients) have no associated diseases (79.3%) while the other patients who have
associations most of them show positive association with type 1 DM (16.4%).
Fifty patients (35.7%) presented with short stature, (25.7%) came with diarrhea. The other symptoms vary
between bloating and distention, unexplained anemia and weight loss. Constipation was seen in one patient.
tTG IgA and tTG IgG showed high sensitivity, specificity, positive predictive value and negative predictive
value while antigliadin antibody failed to show these significant results.Conclusion: The use of serologic markers in
celiac is easy, direct, noninvasive and reliable
and could be benefit in the diagnosis and
monitoring of the disease. More specifically,
both the tTG-IgA/IgG are very good markers
in the diagnostis of CD. This study confirmed
the high specificity and sensitivity of tTG, and the low results of AGA, but celiac serology does not replace the biopsy in the diagnosis but is useful as an
assistant for diagnosis.
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