In a developing country, many conditions other then celiac disease (CD) can give rise to villous atrophy.
In this study, a research team from India assessed the role of immunoglobulin A (IgA)-antigliadin antibody (AGA), in addition to the ESPGHAN criteria, in the diagnosis of CD.
The team evaluated 104 consecutive children with suspected CD (mean age 6 years, male to female ratio 3:2), over a 3-year period, with an intention to diagnose CD.
Children with suspected CD, but who had a normal duodenal biopsy formed a control. This group comprised 47 children with a mean age of 7 years.
They performed a complete hemogram, d-xylose absorption test, endoscopic duodenal biopsy, and IgA-AGA titers for all patients.
CD was diagnosed on the basis of modified ESPGHAN criteria irrespective of IgA-AGA positivity (greater than 5 U/ml). Those diagnosed were put on gluten-free diet and were monitored regularly.
The researchers found that the mean duration of symptoms was 3 years.
They found that the predominant symptoms were pallor in 96% of patients, failure to thrive in 92%, and diarrhea in 80%.
|Diarrhea, anemia, low weight, and stunting more frequent in patients with celiac disease.|
|Journal of Pediatric Gastroenterology and Nutrition|
On follow-up, symptoms subsided within 16 days, and patients showed significant weight gain, as well as height gain.
When the team compared the CD group with the control group, diarrhea, anemia, low weight, and stunting were significantly more frequent in patients with CD.
In addition, the team found the sensitivity and specificity of AGA at a cutoff value of 5 U/ml were 94% and 92%, and at 10 U/ml 88% and 100%, respectively.
A follow-up AGA test was performed in 42 of 47 positive cases. All cases showed a significant decrease in AGA titer, and 70% had a negative test result.
Dr Ujjal Poddar's team, from the Postgraduate Institute of Medical Education and Research, Chandigarh, concluded that, "Indian children with CD are true cases of CD".
"They present late, diarrhea is absent in 20% of cases, and AGA test results show 88% of children without false-positive results at a cutoff value of 10 U/ml.
"However, AGA test with 94% sensitivity at a cutoff value of 5 U/ml can be used as screening test to select suspected cases for further workup".