Utility of serological tests for the clinical diagnosis of celiac disease in children in diyala province

Background: Celiac disease (CD) is an immune-mediated systemic condition triggered by dietary gluten occurring in genetically susceptible individuals. CD has a wide range of clinical manifestations. A number of serologic tests were implemented in the diagnosis of CD. Objectives: This case-control study was arranged to evaluate the validity of clinical presentations and to assess the clinical utility of serologic tests in the diagnosis of CD in children in Diyala province. Subjects and Methods: The present study was conducted in Diyala province-Iraq during the period from September 2011 to April 2012 in Al-Batool Teaching Hospital for Maternity and Children. One hundred sixty five children who were clinically suspected as having CD and 124 healthy children as control group were enrolled. The patient's age range was 1 month to 6 years and above. Information regarding age, sex, residence, family history, and clinical signs were collected in a special questionnaire. Commercially available serological kits for anti-gliadin IgA (AGA-IgA) and anti- tissue transglutaminase IgA (anti-tTG-IgA) antibodies (Aeskulisa, Germany) were used by ELISA technique. Data were statistically analyzed, and P value < 0.05 was considered significant. Results: Based on the seropositivity of both anti-AGA IgA and anti-tTG IgA, 15 (9.6%) were considered CD patients. whereas, patients who had either anti-AGA IgA (16.7%) or anti-tTG IgA (14.7%) positive were considered as symptomatic non-CD patients. The results showed that the anti-AGA IgA and anti-tTG IgA seropositivity was highly significant (P< 0.001) in CD patients compared to symptomatic non-CD patients and control groups. The anti-tTG IgA has higher specificity, accuracy, and positive predictive value. Two or more clinical manifestations together were significantly increase the validity of clinical diagnosis of CD, and correlate well with the results of serological tests. Conclusion: CD has wide intestinal and extraintestinal clinical manifestations. Accordingly, patients presented with two or more of these clinical manifestations should be serologically screened for CD. The anti-AGA IgA and more specifically the anti-tTG IgA are highly informative for early detection of CD.