Clinical accuracy of anti-tissue transglutaminase as screening test for celiac disease under 2 years

Aim:  To investigate, in patients with suspected celiac disease (CD) younger than 2 years, the clinical value of anti-tissue transglutaminase (tTG) in diagnostic work-up of CD. Methods:  Between June 2005 and June 2009, 169 patients aged <2 years, with symptoms suggestive of CD, were submitted to biopsy. CD diagnosis was based on the revised criteria of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. Results:  Of the 169 patients enrolled, 155 were included: 108 of them showed mucosal atrophy and 47 negative histology. Sensitivity and specificity of tTG, at the cut-off of 8 AU/mL, were 0.96 (CI 0.91–0.99) and 0.91 (CI 0.80–0.98), respectively, with likelihood ratio (LR) of 11.31; at the cut-off of 16 AU/mL, they were 0.79 (CI 0.70–0.86) and 1.00, respectively (CI 0.92–1.00), with LR 4.50. Conclusions:  In patients younger than 2 years, suspected for CD, tTG is very valuable in selecting for small intestinal biopsy.