Serum Anti TTG Level as a Predictor for Severity of Intestinal Damage in Children with Celiac Disease

AbstractIntroduction: This study aimed at evaluating how the patient’s clinical manifestations and his/her anti TTG level are correlated with the intensity of histological damage based on the classification of Marsh Oberhuber.Methods: This cross-sectional study was performed on 186 children suspected to celiac disease who referred to gastroenterology clinic between 2014 and 2015 and had Anti TTG >20. All patients underwent upper gastrointestinal endoscopy and multiple biopsies of duodenum were taken; histological classification was performed based on Marsh Oberhuber criteria. Finally, the relationship between serum levels of Anti TTG and histologic findings was assessed based on Marsh Oberhuber criteria.Results: There was a statistically significant difference between Anti TTG and different classes of grading March (P=0.01). Moreover, the intensity of intestinal damage based on Marsh Oberhuber criteria was significantly higher in children who referred with gastrointestinal complaints, the classic form of celiac disease and growth disorder. Anti TTG level of 148 IU/ml was the best positive cutoff point suggested by the ROC. For anti TTG level of 148 IU/ml, sensitivity, specificity, positive predictive value and negative predictive value were 46.8%, 82.4%, 91.7%, and 27.2%, respectively.Conclusion: Anti TTG level of 148 IU/ml has a high positive predictive value and a low negative predictive value for histologic changes more than grade 1 in Marsh classification.