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Usefulness of Small-bowel Mucosal Transglutaminase-2 Specific Autoantibody Deposits in the Diagnosis and Follow-up of Celiac Disease

Koskinen, Outi MD*; Collin, Pekka MD† ‡; Lindfors, Katri PhD*; Laurila, Kaija MSc*; Mäki, Markku MD* † §; Kaukinen, Katri MD* † ‡

Journal of Clinical Gastroenterology: August 2010 - Volume 44 - Issue 7 - p 483-488
doi: 10.1097/MCG.0b013e3181b64557
ALIMENTARY TRACT: Original Articles

Background Diagnosis of celiac disease may be problematic in that small-bowel villous atrophy sometimes occurs in conjunction with other enteropathies, develops gradually and may be patchy. Furthermore, as the often compromised quality of biopsy specimens renders diagnosis difficult, new diagnostic tools are warranted.

Goals As the celiac disease-specific autoantibodies are found deposited at their production site, in the small-bowel mucosa, they may be useful in diagnostics, especially in problematic cases. We therefore systematically assessed the occurrence of celiac-specific autoantibody deposits in a large cohort of celiac patients, and established how IgA deposits decline after initiation of a gluten-free diet.

Methods Transglutaminase-2 specific mucosal IgA autoantibody deposits were determined from small-bowel mucosal biopsies in 261 untreated, 71 short-term (1 y), and 105 long-term (2 to 41 y) treated celiac disease patients and in 78 nonceliac controls. The presence of the deposits was compared with celiac serology, mucosal villous morphology and density of intraepithelial lymphocytes.

Results All untreated celiac disease patients had mucosal autoantibody deposits and their intensity was moderate or strong in 90% of cases. In contrast, 18% of the controls had weak depositions. During a gluten-free diet the intensity of the deposits diminished, but was still faintly positive in 56% of long-term treated celiac patients. The efficiency of the test in determining mucosal autoantibody deposits was superior to serology and inflammatory markers.

Conclusions Mucosal transglutaminase-2 specific autoantibody deposits proved to be accurate gluten-dependent markers of celiac disease and would thus be of value in the diagnostics and dietary monitoring of this disorder.

*Pediatric Research Center

Medical School, University of Tampere

Departments of Gastroenterology and Alimentary Tract Surgery

§Pediatrics, Tampere University Hospital, Tampere, Finland

The Celiac Disease Study Group has been financially supported by the Research Council for Health, the Academy of Finland, the Pediatric Research Foundation, the Competitive Research Funding of the Pirkanmaa Hospital District, the Research Fund of the Finnish Celiac Society, the Sigrid Juselius Foundation and the European Commission (contract number MRTN-CT-2006-036032).

Reprints: Katri Kaukinen, MD, Medical School, FIN-33014 University of Tampere, Tampere, Finland (e-mail:

Received for publication May 12, 2009

accepted July 6, 2009

The authors declare no conflict of interest.

© 2010 by Lippincott Williams & Wilkins