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Prediction of Clinical and Mucosal Severity of Coeliac Disease and Dermatitis Herpetiformis by Quantification of IgA/IgG Serum Antibodies to Tissue Transglutaminase

Dahlbom, Ingrid*; Korponay-Szabó, Ilma R; Kovács, Judit B; Szalai, Zsuzsanna; Mäki, Markku||; Hansson, Tony*

Journal of Pediatric Gastroenterology and Nutrition: February 2010 - Volume 50 - Issue 2 - p 140–146
doi: 10.1097/MPG.0b013e3181a81384
Original Articles: Gastroenterology

Objectives: We analysed whether the quantification of autoantibodies against tissue transglutaminase could be used to predict mucosal destruction and disease severity in patients with gluten sensitivity.

Patients and Methods: One hundred seventy patients with coeliac disease (CD), comprising 52 children with severe malabsorption (group I), 59 children with mild symptoms (group II), 59 adults (group III), 134 patients with dermatitis herpetiformis (DH), and 131 disease controls, were studied. Serial serum samples of patients in groups I and II on a gluten-free diet were also included. Serum levels of antibodies against recombinant tissue transglutaminase were determined with ELISA using standard curves for quantification of antibodies.

Results: Immunoglobulin (Ig)A antibodies against tissue transglutaminase (IgA-TGA) were detected in all of the patients with CD and in 95% of the DH patients. The IgA-TGA and IgG-TGA levels were higher in group I (P < 0.001). The IgG-TGA levels and positivity rate in group I (100%) were higher than in group II (81%), group III (73%), and the DH group (67%). Elevated IgA-TGA and IgG-TGA levels in combination predicted a more severe small intestinal atrophy (P < 0.0001) with a specificity of 99% for Marsh IIIb–IIIc (flat) lesions. The kinetics of the IgA-TGA decrease during diet differed between groups I and II.

Conclusions: High levels of IgA-TGA and IgG-TGA antibodies were associated with the grade of mucosal villous atrophy and a more severe clinical presentation. The combined measurement of IgA-TGA and IgG-TGA enables a noninvasive prediction of small intestinal villous atrophy with high accuracy, and may reduce the need for a biopsy in patients with suspected CD.

*Department of Women's and Children's Health, Uppsala University, Sweden

Heim Pál Children's Hospital, Department of Gastroenterology-Nephrology, Hungary

Department of Dermatology, Budapest, Hungary

||Paediatric Research Centre, Tampere University Hospital and University of Tampere, Tampere, Finland.

Received 9 July, 2008

Accepted 25 March, 2009

Address correspondence and reprint requests to Ingrid Dahlbom, PhD, Department of Women's and Children's Health, Paediatrics, Uppsala University Hospital, Entrance 95, Ground floor, SE 751 85 Uppsala, Sweden (e-mail:

Drs Dahlbom and Korponay-Szabó contributed equally to the article.

The study was supported by the Hungarian Scientific Research Fund (OTKA K61868), the Research Fund of Tampere University Hospital, the Foundation of the Friends of the University Children's Hospitals in Finland, the Finnish Coeliac Society, the Gillbergska Foundation, Uppsala, Sweden, and the Swedish Governmental Agency for Innovation Systems (VINNOVA Sambio 2007-00084).

The authors report no conflicts of interest.

© 2010 Lippincott Williams & Wilkins, Inc.