Association of Anti-Tissue Transglutaminase Antibodies with Intestinal Damage in Celiac Disease

Abstract

Objective: To study the prevalence of celiac disease in different age groups ranging from 07 months-22 years  in Multan and its periphery and the role of anti-tissue transglutaminase antibodies in the diagnosis of celiac disease.

Study Design: Descriptive / cross sectional study

Place and Duration of Study: This study was conducted at the Nishtar Medical College and Hospital Laboratory Multan from January 2016 to June 2016.

Materials and Methods: This study was conducted on 178 patients received at Nishtar medical unit III, both male and females, from the age group 07 months to 22 years with the suspicion of celiac disease(CD). All duodenal biopsy cases, in whom anti-tissue transglutaminase antibody test was conducted prior to duodenal biopsy, referred to Nishtar medical college and hospital laboratory Multan from the January 2016 to June 2016 were reviewed.All data was entered and analyzed by using statistical software SPSS version 23.1. Mean ± SD calculated for numerical data and categorical data was presented as frequency and percentages. Chi square test was applied to see effect modification and p value ≤ 0.05 considered as significant.

Results: Out of 178 cases that had been reviewed, 96 (53.93%)cases fulfilled the diagnostic criteria of CD, 76(42.70%) patients had non specific enteritis and duodenitis and 6 (3.37%)patients were suggested a repeat biopsy as celiac disease could not be ruled out. Out of these 96 cases, 35 (36.46%) had infiltrative hyperplastic stage marsh type 2 on histopathology, 34(35.42%) had 3a type and 27 (28.12%) had 3b type according to Marsh criteria. Out of these 96 patients, 49 (51%) had positive anti-tissue transglutaminase IgA antibodies. 24(48.98%) patients who had high titers ranging from >60->800 fell under 3b Marsh Type, 16(32.65%) patients had titers ranging from >25-300 had Marsh Type 3a, 09(18.37%) patients had titers ranging from >10-40 had Type 2 on histopathology.

Conclusion: Celiac disease may present at any age but predominantly in young age groups. Celiac disease is not a rare disease in Multan and its periphery. Duodenal biopsies play a significant role in diagnosis of CD as compared to serological tests. Anti TTG IgA is more sensitive and shows high titer only in severe cases of CD with Type 2 and above Marsh classification. However, Anti tissue transglutaminase IgG antibodies as compared to transglutaminase IgA didn’t show any significant prevalence pattern.