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Journal of Clinical Gastroenterology 2003; 36(3):219-221

Prevalence of Antitissue Transglutaminase Antibodies in Different Degrees
of Intestinal Damage in Celiac Disease
Antonio Tursi, M.D.; Giovanni Brandimarte, M.D.; Gian Marco Giorgetti, M.D.

Abstract

Goals:
Although anti-tissue transglutaminase antibodies (anti-tTG) are effective
for celiac disease (CD) routine laboratory screening, there are no studies
evaluating correlation between degree of intestinal damage and positivity
to anti-tTG. Since recent studies showed that anti-gliadin (AGA) and anti-
endomysium (EMA) antibodies are ineffective in diagnosing mild gluten-
sensitive enteropathy, the aim of this study was to evaluate the prevalence
of anti-tTG in different degrees of intestinal damage of celiac patients
and whether there is a correlation between serum value of anti-tTG and the
degree of histologic damage.

Study:
We studied 119 consecutive adult patients affected by CD (47 men and 72
women; mean age, 28 years; range, 22-51 years). All patients were
stratified for histologic damage according to Marsh classification, and in
all of them an anti-tTG evaluation was performed.

Results:
Marsh I lesions were present in 13 patients (10.92%), Marsh II in 24 anti-
tTG (20.16%), Marsh IIIa in 27 anti-tTG (22.68%), Marsh IIIb in 31 anti-tTG
(26.05%) and Marsh IIIc in 24 anti-tTG (20.16%). Anti-tTG positivity was
ranging from 1 of 13 anti-tTG (7.69%) in Marsh I lesions to 23 of 24 anti-
tTG (95.83%) in Marsh IIIc lesions respectively (P < 0.005), while mean
serum value of anti-tTG ranged from 3.61 (range, 0.7-9.2) UA/mL in Marsh I
lesions to 7.3 (range, 1-25.1), 18.5 (range, 1.8-56.2), 36 (range, 3.7-
83.5) and 74.95 (range, 6.5-257) UA/mL in Marsh II, IIIb and IIIc lesions
respectively (P < 0.005).

Conclusions:
Our study showed that anti-tTG prevalence and their mean serum value was
higher in celiacs with severe enteropathy (Marsh IIIb-c lesions) than in
those showing slight enteropathy (Marsh I-IIIa). So, serologic tests
without histologic evaluation may underestimate the real prevalence of CD
and there is the risk of delaying the diagnosis of CD in patients who run
an increased risk of deficiencies, non-malignant conditions and malignancy.

http://www.jcge.com/article.asp?ISSN=0192-0790&VOL=36&ISS=3&PAGE=219

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