Celiac disease in infants: antibodies to deamidated gliadin peptide come first!
Arigliani et al. Italian Journal of Pediatrics (2017) 43:70
DOI 10.1186/s13052-017-0392-6
The onset of celiac disease (CD) in the first year of life is uncommon and the diagnosis can be challenging due to the suboptimal sensitivity of tissue transglutaminase antibodies (tTG) at this age and the many other possible causes of malabsorption in infants.
DOI 10.1186/s13052-017-0392-6
The onset of celiac disease (CD) in the first year of life is uncommon and the diagnosis can be challenging due to the suboptimal sensitivity of tissue transglutaminase antibodies (tTG) at this age and the many other possible causes of malabsorption in infants.
This report describes a case of an 8-month-old child who was evaluated for failure to thrive and developmental delay. For the first 5 months of life, the child had been exclusively breastfed with a normal growth and development. After weaning, at between 6 and 8 months, the patient developed constipation, bulky stools, irritability, and anorexia, with no association with a specific event. The child was admitted to the University Hospital of Udine, Italy, where laboratory tests revealed a normal full blood count. A screening for CD revealed normal IgA levels, absence of tTG antibodies but positive serum antibodies to deamidated gliadin peptides (anti-DGPs). An esophagogastroduodenoscopy with duodenal biopsy showed complete villous atrophy. Within 4 months of initiating a gluten-free diet, body weight, neurological evaluation, and laboratory parameters were completely normal. Six months after, IgG anti-DGP results were still slightly positive, while IgA anti-tTG were absent. The next six months and for the next 2 years both DGP and tTG antibodies were negative.
This case report demonstrates the utility of IgG anti-DGPs for screening infants with suspected celiac disease and supports evidence from previous studies indicating anti-DGPs are a sensitive marker of CD in very young children and may be the first CD antibodies to seroconvert. Due to a possible immature adaptive immune response at this age, some children who develop celiac disease show a sole production of anti-DGPs even in the presence of villous atrophy. However, sole positivity of serum anti-DGPs as a marker of celiac disease in very young children should be considered with caution since previous studies have demonstrated poor positive predictive value from the use of positive anti-DGPs alone. The authors suggest that symptomatic HLA DQ2/DQ8 positive children with DGP-positive/tTG-negative antibodies should be offered a duodenal biopsy to exclude a celiac disease. Further studies are required to provide a more detailed evaluation of this serological pattern.
Link to original paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553580/
This case report demonstrates the utility of IgG anti-DGPs for screening infants with suspected celiac disease and supports evidence from previous studies indicating anti-DGPs are a sensitive marker of CD in very young children and may be the first CD antibodies to seroconvert. Due to a possible immature adaptive immune response at this age, some children who develop celiac disease show a sole production of anti-DGPs even in the presence of villous atrophy. However, sole positivity of serum anti-DGPs as a marker of celiac disease in very young children should be considered with caution since previous studies have demonstrated poor positive predictive value from the use of positive anti-DGPs alone. The authors suggest that symptomatic HLA DQ2/DQ8 positive children with DGP-positive/tTG-negative antibodies should be offered a duodenal biopsy to exclude a celiac disease. Further studies are required to provide a more detailed evaluation of this serological pattern.
Link to original paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553580/
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