A1 Refereed original research article in a scientific journal
Celiac disease antibody levels reflect duodenal mucosal damage but not clinical symptoms
Authors: Käräjämäki Aki J., Taavela Juha, Nielsen Christian, Lönnqvist Mårten, Svartbäck Marcus, Kaukinen Katri, Tertti Risto
Publisher: TAYLOR & FRANCIS LTD
Publication year: 2021
Journal: Scandinavian Journal of Gastroenterology
Journal name in source: SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY
Journal acronym: SCAND J GASTROENTERO
Volume: 56
Issue: 5
First page : 514
Last page: 519
Number of pages: 6
ISSN: 0036-5521
eISSN: 1502-7708
DOI: https://doi.org/10.1080/00365521.2021.1899278
Abstract
Objectives
This study aimed to investigate, in a real-world population, whether the histological and clinical phenotype differ at baseline and during follow-up in patients with high and low CD (celiac disease) antibody titers.
Materials and methods
The study cohort consisted of 96 consecutive patients diagnosed to have CD during the years 2010-2018. The clinical parameters, symptoms and laboratory results were registered and histomorphometry was analyzed from the available duodenal biopsies taken during the primary and follow-up esophageal-gastricduodenoscopies. Patients having immunoglobulin A transglutaminase antibody (tTG-ab) levels above 70 U/mL were classified as high titer patients.
Results
Measured by the villous-crypt ratio, the duodenal mucosa was more severely damaged in the high tTG-ab group than in the low tTG-group at baseline (n = 70, 0.61 +/- 0.63 vs. 1.02 +/- 0.87, p = .003) and during the follow-up when the patients were on gluten-free diet (n = 27, 1.80 +/- 0.72 vs. 2.35 +/- 0.64, p = .041). Interestingly, the high tTG-ab group members had fewer gastrointestinal symptoms at baseline than those in the low tTG-ab group (43% vs. 68%, p = .013) but lower vitamin D levels (68 +/- 34 nmol/L vs. 88 +/- 29 nmol/L, p = .034) and more often microcytosis (28% vs. 10%, p = .040). During the follow-up, these differences were no longer detected.
Conclusions
At baseline, CD patients with high tTG-ab have more severe duodenum injury and signs of malabsorption but fewer symptoms. After gluten-free diet has been initiated, the mucosal healing in the high tTG-ab group is prolonged, but symptoms and signs of malabsorption recover equally in both groups.
Objectives
This study aimed to investigate, in a real-world population, whether the histological and clinical phenotype differ at baseline and during follow-up in patients with high and low CD (celiac disease) antibody titers.
Materials and methods
The study cohort consisted of 96 consecutive patients diagnosed to have CD during the years 2010-2018. The clinical parameters, symptoms and laboratory results were registered and histomorphometry was analyzed from the available duodenal biopsies taken during the primary and follow-up esophageal-gastricduodenoscopies. Patients having immunoglobulin A transglutaminase antibody (tTG-ab) levels above 70 U/mL were classified as high titer patients.
Results
Measured by the villous-crypt ratio, the duodenal mucosa was more severely damaged in the high tTG-ab group than in the low tTG-group at baseline (n = 70, 0.61 +/- 0.63 vs. 1.02 +/- 0.87, p = .003) and during the follow-up when the patients were on gluten-free diet (n = 27, 1.80 +/- 0.72 vs. 2.35 +/- 0.64, p = .041). Interestingly, the high tTG-ab group members had fewer gastrointestinal symptoms at baseline than those in the low tTG-ab group (43% vs. 68%, p = .013) but lower vitamin D levels (68 +/- 34 nmol/L vs. 88 +/- 29 nmol/L, p = .034) and more often microcytosis (28% vs. 10%, p = .040). During the follow-up, these differences were no longer detected.
Conclusions
At baseline, CD patients with high tTG-ab have more severe duodenum injury and signs of malabsorption but fewer symptoms. After gluten-free diet has been initiated, the mucosal healing in the high tTG-ab group is prolonged, but symptoms and signs of malabsorption recover equally in both groups.
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