Association Between Tissue Transglutaminase IgA Levels and Villous Atrophy in Pediatric Celiac Disease: A Retrospective Cross-Sectional Study
- 1Şanlıurfa Training and Research Hospital, Clinic of Pediatric Gastroenterology, Şanlıurfa, Türkiye
- 2Şanlıurfa Training and Research Hospital, Clinic of Pathology, Şanlıurfa, Türkiye
- 3Harran University Faculty of Medicine, Department of Pediatrics, Şanlıurfa, Türkiye
Abstract
Objective: The 2020 European Society for Paediatric Gastroenterology, Hepatology and Nutrition no-biopsy algorithm for celiac disease (CD) requires a tissue transglutaminase IgA (tTG-IgA) level ≥10× the upper limit of normal (ULN) plus endomysial antibody IgA (EMA-IgA) positivity on a second sample. This study evaluated the diagnostic performance of the tTG-IgA ≥10× ULN threshold for predicting Marsh grade 3 histology at a center where EMA-IgA testing was not routinely available. Methods: This retrospective study included pediatric patients who underwent duodenal biopsy for suspected CD between January and December 2023 at Şanlıurfa Training and Research Hospital. Patients were categorized as tTG-IgA <10× ULN or ≥10× ULN. Sensitivity, specificity, predictive values, accuracy, and Cohen’s kappa were calculated using Marsh grade 3 as the reference standard. Factors associated with Marsh grade 3 were assessed using univariable logistic regression. Results: Of 141 patients, 108 (76.6%) had tTG-IgA ≥10× ULN and 130 (92.2%) had Marsh grade 3 histology. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for the threshold were 78.5%, 45.5%, 94.4%, 15.2%, and 75.9%, respectively. Agreement with Marsh grade 3 was low [κ=0.125; 95% confidence interval (CI), -0.040 to 0.290; p=0.072]. Any bulbar or distal duodenal endoscopic abnormality was associated with Marsh grade 3 (odds ratio =11.810; 95% CI, 2.697-51.703; p=0.001). Conclusion: At our institution, without routine EMA-IgA testing, tTG-IgA levels ≥10× ULN had high PPV for advanced histological injury; however, this marker alone was insufficient as a no-biopsy diagnostic criterion.
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BibTeX
@article{duztas2026association,
title = {{Association Between Tissue Transglutaminase IgA Levels and Villous Atrophy in Pediatric Celiac Disease: A Retrospective Cross-Sectional Study}},
author = {Demet TEKER DÜZTAŞ and Gizem AY HALDIZ and Aydın BOZKAYA},
journal = {Forbes Tıp Dergisi},
year = {2026},
month = oct,
doi = {10.4274/forbes.galenos.2026.22220},
url = {https://doi.org/10.4274/forbes.galenos.2026.22220},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Association Between Tissue Transglutaminase IgA Levels and Villous Atrophy in Pediatric Celiac Disease: A Retrospective Cross-Sectional Study
AU - Demet TEKER DÜZTAŞ
AU - Gizem AY HALDIZ
AU - Aydın BOZKAYA
PY - 2026
DA - 2026/10/28
JO - Forbes Tıp Dergisi
DO - 10.4274/forbes.galenos.2026.22220
UR - https://doi.org/10.4274/forbes.galenos.2026.22220
AB - Objective: The 2020 European Society for Paediatric Gastroenterology, Hepatology and Nutrition no-biopsy algorithm for celiac disease (CD) requires a tissue transglutaminase IgA (tTG-IgA) level ≥10× the upper limit of normal (ULN) plus endomysial antibody IgA (EMA-IgA) positivity on a second sample. This study evaluated the diagnostic performance of the tTG-IgA ≥10× ULN threshold for predicting Marsh grade 3 histology at a center where EMA-IgA testing was not routinely available. Methods: This retrospective study included pediatric patients who underwent duodenal biopsy for suspected CD between January and December 2023 at Şanlıurfa Training and Research Hospital. Patients were categorized as tTG-IgA <10× ULN or ≥10× ULN. Sensitivity, specificity, predictive values, accuracy, and Cohen’s kappa were calculated using Marsh grade 3 as the reference standard. Factors associated with Marsh grade 3 were assessed using univariable logistic regression. Results: Of 141 patients, 108 (76.6%) had tTG-IgA ≥10× ULN and 130 (92.2%) had Marsh grade 3 histology. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for the threshold were 78.5%, 45.5%, 94.4%, 15.2%, and 75.9%, respectively. Agreement with Marsh grade 3 was low [κ=0.125; 95% confidence interval (CI), -0.040 to 0.290; p=0.072]. Any bulbar or distal duodenal endoscopic abnormality was associated with Marsh grade 3 (odds ratio =11.810; 95% CI, 2.697-51.703; p=0.001). Conclusion: At our institution, without routine EMA-IgA testing, tTG-IgA levels ≥10× ULN had high PPV for advanced histological injury; however, this marker alone was insufficient as a no-biopsy diagnostic criterion.
SN - 2757-5241
ER -