Measured levels of positive transglutaminase 2 antibodies are not associated with presentation or incidental endoscopic findings at celiac disease diagnosis

Abstract

Objectives

It has been suggested that celiac disease could be diagnosed non-invasively in adults with transglutaminase antibody (TGA) levels >10x upper limit of normal (ULN). It is, however, unclear if high values signify more advanced disease and higher risk of co-morbidities. We investigated the association between the TGA levels, clinical characteristics and non-celiac endoscopic findings.

Methods

Medical data on 450 celiac disease patients at diagnosis were collected. They were further divided into those with high positive (>10x ULN, n = 164), moderately positive (1–10x ULN, n = 219), and negative (n = 67) TGA.

Results

Median age of patients was 50 years and 60% were women. Patients with negative TGA were older (median age 58 vs. 51 vs. 46 years respectively, p = 0.002) and had more often weight loss (27% vs. 10% vs. 9%, p < 0.001) and abdominal pain or dyspepsia (40% vs 27% vs. 22%, p = 0.017) than did those with moderately positive/high TGA. The groups did not differ in sex, BMI, or other symptoms. Major endoscopic findings included one esophageal adenocarcinoma presenting with dysphagia, six esophagitis, three gastric ulcers, and 39 H. Pylori or other active gastritis. High, moderately positive or negative TGA levels were not associated with these findings in crude or age-adjusted analyses.

Conclusions

Presentation was similar in patients with moderate or high levels of TGA, whereas patients with negative TGA were different. The level of TGA was not associated with incidental endoscopic findings and the only malignancy presented with an alarm symptom atypical to celiac disease.

Keywords:

• Celiac disease
• endoscopy
• serology testing
• adults
• no-biopsy

Specific author contributions

Eneli Katunin: designing the study, interpreting data, statistical analyses, writing the manuscript; Linnea Aitokari: designing the study, interpreting data, drafting the manuscript, critical review of the paper for important intellectual content; Heini Huhtala: designing the study, statistical analyses, interpreting data, critical review of the paper for important intellectual content; Laura Kivelä: interpreting data, critical review of the paper for important intellectual content; Tuire Ilus: interpreting data, critical review of the paper for important intellectual content; Katri Kaukinen: designing the study, collecting and interpreting data, critical review of the paper for important intellectual content; Kalle Kurppa: designing the study, collecting and interpreting data, drafting the manuscript, critical review of the paper for important intellectual content

Disclosure statement

No potential conflict of interest was reported by the authors.

Financial support

This study was supported by the Competitive State Research Financing of the Expert Area of Tampere University Hospital, the Päivikki and Sakari Sohlberg Foundation, the Sigrid Juselius Foundation, the Finnish Cultural Foundation, the Paulo Foundation, the Emil Aaltonen Foundation, the Finnish Coeliac Society, the Foundation for Pediatric Research, and the Academy of Finland (grant numbers 339183 and 347473).