Pediatric Typical Vs. Atypical Celiac Disease: Correlation of Duodenal Histology With Tissue Transglutaminase Levels

Abstract

Background: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a 103 pediatric patient with coeliac disease. This study also aimed to determine the correlation of anti tTG level and the degree of mucosal damage in typical and atypical cases.

Methods: The medical records of patients with newly diagnosed CD during the period of 2006 - 2010 were retrospectively reviewed.

Results: A total of 103 patients fulfilled the established CD diagnostic criteria (mean age: 6.6 years; mediana: 5 years). A typical CD presentation was observed for 66/103 (64.1%) children vs atypical 37/103 (35.9%). The levels of tTG antibody were correlated significantly with Marsh types in the entire population by Spearman rank correlation (r = 0.661, P < 0.0001), and separately for typical(r = 0.633, P < 0.001) and atypical (r = 0.574, P < 0.0001) groups. Histopathological evaluation of intestinal biopsies revealed total or subtotal VA in 44 patients (66.6%) in the typical group, and 24 patients (64.8%) in the atypical group. Partial VA was observed in 5 patients (7.5%) in the typical group and 1 (2.7%) patients in atypical group. There was no correlation of mode of presentation (typical and atypical) with the degree of villous atrophy by a non-parametric Mann-Whitney U test Z= -1.437, P = 0.151.

Conclusion: There is a positive correlation between tTG antibody serum level and duodenal histopathology in typical as in atypical pediatric CD. The degree of villous atrophy did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for typical simptoms in coeliac disease.




doi: http://dx.doi.org/10.4021/ijcp57w