Objective: The diagnosis of coeliac disease (CD) is often delayed because many children are free from the major symptoms characteristic of this enteropathy. The aim of the present study was to determine the efficacy of antibodies directed against tissue transglutaminase (tTG Abs) for early detection of CD in a population with few symptoms of the disease, as well as in children with an autoimmune disorder.
Methods: This was a prospective study in a paediatric population including 638 patients with clinical symptoms frequently associated with CD, autoimmune diseases such as type 1 diabetes mellitus (DM1), autoimmune thyroiditis or hepatitis, and Turner's syndrome. Anti-endomysium, tTG Abs and antigliadin antibodies were analysed in these patients using an indirect immunofluorescence technique and enzyme-linked immunosorbent assay techniques. Intestinal biopsies were performed for some patients with positive or negative antibodies.
Results: tTG Abs were detected in 2.6% of children with symptoms associated with CD, such as digestive signs and growth failure, and in 5.4% of children with DM1. No other autoimmune disease was positive for tTG Abs. Biopsies performed in the patients with positive tTG Abs showed mucosal atrophy confirming the diagnosis of CD in all cases.
Conclusion: Children displaying minimal symptoms frequently associated with CD and children with DM1 should be systematically screened for tTG Abs.
aDepartment of Immunology, Lyon-Sud Hospital (CHLS), Hospices Civils de Lyon (HCL), Lyon, France
bDepartment of Immunology
cDepartment of Paediatrics, Debrousse Hospital, Lyon, France
dDepartment of Paediatrics
eDepartment of Anatomopathology, Edouard Herriot Hospital, Lyon, France
Sponsorship: This work was supported by grants from the Hospices Civils de Lyon and the Comité Mixte de Coopération Franco-Tunisienne.
Correspondence and requests for reprints to Dr Nicole Fabien, Laboratoire d'Auto-Immunité, Centre Hospitalier Lyon-Sud (Hospices Civils de Lyon), Chemin du Grand Revoyet, 69495 Pierre-Bénite Cedex, France
Tel: +33 478866681; fax: +33 478863344;
Received 27 May 2004 Revised 13 September 2004 Accepted 18 October 2004