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Diagnostic Value of Anti-deamidated Gliadin Peptide IgG Antibodies for Celiac Disease in Children and IgA-deficient Patients

Mozo, Lourdes*; Gómez, Jesús*; Escanlar, Esther*; Bousoño, Carlos; Gutiérrez, Carmen*

Journal of Pediatric Gastroenterology & Nutrition: July 2012 - Volume 55 - Issue 1 - p 50–55
doi: 10.1097/MPG.0b013e31824703c7
Original Articles: Gastroenterology

Objectives: The aim of the study was to analyze the diagnostic performance of anti-deamidated gliadin peptide (dGp) immunoglobulin (Ig) G and IgA regarding the age at celiac disease (CD) diagnosis and the anti-dGp IgG usefulness for diagnosing CD IgA-deficient patients.

Methods: Anti-dGp IgG and IgA and anti-native gliadin (nGlia) IgA were determined by enzyme fluoroimmunoassay in 100 newly diagnosed anti-tissue transglutaminase (tTG) IgA-positive pediatric and adult patients with CD and in 100 age-matched patients with other digestive pathologies. Anti-dGp IgG was evaluated in 6 CD IgA-deficient patients.

Results: When analyzing all of the patients, the anti-dGp IgG assay showed higher diagnostic accuracy (area under receiver operating characteristic curve), specificity, and positive predictive value than anti-dGp IgA and anti-nGlia IgA. All of the diagnostic parameters corresponding to anti-dGp IgG reached the same values as anti-tTG IgA in children 7 years or younger. In older patients, both anti-dGp isotypes showed an inverse behavior, IgG having a higher specificity and positive predictive value but a lower sensitivity and negative predictive value than IgA. Anti-dGp levels were associated with the severity of intestinal lesions, and an inverse association was found regarding age at diagnosis. Both anti-dGp IgG and IgA were found to be positive in the 9 patients with minimal intestinal changes included in the study. All of the patients with CD with IgA deficiency were positive for anti-dGp IgG.

Conclusions: The diagnostic performance of anti-dGp depends on the antibody isotype and on the age at CD diagnosis, anti-dGp IgG being a serological marker at least as useful as anti-tTG IgA for detecting CD in children ages 7 years or younger. Our data also indicate that anti-dGp IgG can improve the diagnosis of IgA-deficient patients.

*Department of Immunology

Department of Pediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain.

Address correspondence and reprint requests to Dr Lourdes Mozo, Department of Immunology, Hospital Universitario Central de Asturias, Celestino Villamil s/n, 33006 Oviedo, Spain (e-mail: lourdes.mozo@sespa.princast.es).

Received 10 March, 2011

Accepted 16 December, 2011

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN