Rok Seon Choung1, Shahryar Khaleghi1, Amanda K Cartee1, Eric V Marietta1, Joseph J Larson2, Katherine S King2, Otto Savolainen3, Alastair B Ross4, S Vincent Rajkumar5, Michael J Camilleri6, Alberto Rubio-Tapia1, Joseph A Murray7. 1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. 2. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota. 3. Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden. 4. Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden; Proteins and Metabolites Team, AgResearch, Lincoln, New Zealand. 5. Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota. 6. Department of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota. 7. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. Electronic address: murray.joseph@mayo.edu.
Abstract
BACKGROUND & AIMS: Celiac disease can develop at any age, but outcomes of adults with positive results from serologic tests for tissue transglutaminase antibodies (tTGA) without endoscopic determination of celiac disease (called celiac autoimmunity) have not been thoroughly evaluated. We investigated the proportion of adults with celiac autoimmunity at a community medical center and their progression to celiac disease. METHODS: We analyzed waste blood samples from a community clinic from 15,551 adults for tTGA and, if titer results were above 2 U/mL, for endomysial antibody. The blood samples had been collected at 2 time points (median interval, 8.8 years) from 2006 through 2017. We collected data from the clinic on diagnoses of celiac disease based on duodenal biopsy analysis. RESULTS: Of the serum samples collected at the first time point, 15,398 had negative results for tTGA, and 153 had positive results for tTGA (>4 U/mL). Based on medical records, 6 individuals received a diagnosis of celiac disease, for a cumulative incidence of celiac disease diagnosis of 0.06% (95% confidence interval, 0.01-0.11). Forty-nine (0.32%) individuals with a negative result from the first serologic test for tTGA had a positive result from the second test. Among the 153 adults who were tTGA positive at the first time point, 31 (20%) had a subsequent diagnosis of celiac disease, 81 (53%) remained positive for tTGA without a clinical diagnosis of celiac disease, and 41 (27%) had negative test results for tTGA at the second time point. Higher initial tTGA titers, female sex, and a history of hypothyroidism and autoimmune disease were associated with increased risks of subsequent diagnosis of celiac disease. Interestingly, adults whose first blood sample had a positive test result but second blood sample had a negative result for tTGA were older, had lower-than-average initial tTGA titer results, and had a higher mean body mass index than adults whose blood samples were positive for tTGA at both time points and adults later diagnosed with celiac disease. CONCLUSIONS: In an analysis of serum samples collected from a community clinic an average of 8.8 years apart, we found that fewer than 1% of adults with negative results from an initial test for tTGA have a positive result on a second test. Of adults with positive results from the test for tTGA, only 20% are later diagnosed with celiac disease; the remaining individuals maintain persistent increases in tTGA without diagnoses of celiac disease or have negative results from second tests.
BACKGROUND & AIMS:Celiac disease can develop at any age, but outcomes of adults with positive results from serologic tests for tissue transglutaminase antibodies (tTGA) without endoscopic determination of celiac disease (called celiac autoimmunity) have not been thoroughly evaluated. We investigated the proportion of adults with celiac autoimmunity at a community medical center and their progression to celiac disease. METHODS: We analyzed waste blood samples from a community clinic from 15,551 adults for tTGA and, if titer results were above 2 U/mL, for endomysial antibody. The blood samples had been collected at 2 time points (median interval, 8.8 years) from 2006 through 2017. We collected data from the clinic on diagnoses of celiac disease based on duodenal biopsy analysis. RESULTS: Of the serum samples collected at the first time point, 15,398 had negative results for tTGA, and 153 had positive results for tTGA (>4 U/mL). Based on medical records, 6 individuals received a diagnosis of celiac disease, for a cumulative incidence of celiac disease diagnosis of 0.06% (95% confidence interval, 0.01-0.11). Forty-nine (0.32%) individuals with a negative result from the first serologic test for tTGA had a positive result from the second test. Among the 153 adults who were tTGA positive at the first time point, 31 (20%) had a subsequent diagnosis of celiac disease, 81 (53%) remained positive for tTGA without a clinical diagnosis of celiac disease, and 41 (27%) had negative test results for tTGA at the second time point. Higher initial tTGA titers, female sex, and a history of hypothyroidism and autoimmune disease were associated with increased risks of subsequent diagnosis of celiac disease. Interestingly, adults whose first blood sample had a positive test result but second blood sample had a negative result for tTGA were older, had lower-than-average initial tTGA titer results, and had a higher mean body mass index than adults whose blood samples were positive for tTGA at both time points and adults later diagnosed with celiac disease. CONCLUSIONS: In an analysis of serum samples collected from a community clinic an average of 8.8 years apart, we found that fewer than 1% of adults with negative results from an initial test for tTGA have a positive result on a second test. Of adults with positive results from the test for tTGA, only 20% are later diagnosed with celiac disease; the remaining individuals maintain persistent increases in tTGA without diagnoses of celiac disease or have negative results from second tests.
Authors: Carlo Catassi; Debby Kryszak; Bushra Bhatti; Craig Sturgeon; Kathy Helzlsouer; Sandra L Clipp; Daniel Gelfond; Elaine Puppa; Anthony Sferruzza; Alessio Fasano Journal: Ann Med Date: 2010-10 Impact factor: 4.709
Authors: Ellen J van Koppen; Joachim J Schweizer; Cassandra G D S Csizmadia; Yvonne Krom; Herbertien B Hylkema; Annemarie M van Geel; Hendrik M Koopman; S Pauline Verloove-Vanhorick; Maria Luisa Mearin Journal: Pediatrics Date: 2009-04 Impact factor: 7.124
Authors: Jill M Norris; Katherine Barriga; Edward J Hoffenberg; Iman Taki; Dongmei Miao; Joel E Haas; Lisa M Emery; Ronald J Sokol; Henry A Erlich; George S Eisenbarth; Marian Rewers Journal: JAMA Date: 2005-05-18 Impact factor: 56.272
Authors: S Husby; S Koletzko; I R Korponay-Szabó; M L Mearin; A Phillips; R Shamir; R Troncone; K Giersiepen; D Branski; C Catassi; M Lelgeman; M Mäki; C Ribes-Koninckx; A Ventura; K P Zimmer Journal: J Pediatr Gastroenterol Nutr Date: 2012-01 Impact factor: 2.839
Authors: Lars C Stene; Margo C Honeyman; Edward J Hoffenberg; Joel E Haas; Ronald J Sokol; Lisa Emery; Iman Taki; Jill M Norris; Henry A Erlich; George S Eisenbarth; Marian Rewers Journal: Am J Gastroenterol Date: 2006-10 Impact factor: 10.864
Authors: Alberto Rubio-Tapia; Robert A Kyle; Edward L Kaplan; Dwight R Johnson; William Page; Frederick Erdtmann; Tricia L Brantner; W Ray Kim; Tara K Phelps; Brian D Lahr; Alan R Zinsmeister; L Joseph Melton; Joseph A Murray Journal: Gastroenterology Date: 2009-04-10 Impact factor: 22.682
Authors: Govind K Makharia; Prashant Singh; Carlo Catassi; David S Sanders; Daniel Leffler; Raja Affendi Raja Ali; Julio C Bai Journal: Nat Rev Gastroenterol Hepatol Date: 2022-01-03 Impact factor: 46.802
Authors: Valeriia Dotsenko; Mikko Oittinen; Juha Taavela; Alina Popp; Markku Peräaho; Synnöve Staff; Jani Sarin; Francisco Leon; Jorma Isola; Markku Mäki; Keijo Viiri Journal: Cell Mol Gastroenterol Hepatol Date: 2020-07-31