Comparable disease course in pediatric celiac disease with or without endoscopic confirmation at high anti-TG2-IgA-antibody titers

Abstract

Background The guidelines from the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) enable the diagnosis of celiac disease (CD) omitting esophagogastroduodenoscopy (EGD) in patients with high anti-Transglutaminase 2 (TG2)-IgA-antibodies. However, there is uncertainty whether this approach is safe in terms of disease outcomes for all patients. Here, we aimed to investigate the course of anti-TG2-IgA-antibodies, symptomatic response, anthropometric measurements and routine laboratory values in CD patients presenting with high anti-TG2-IgA-antibodies diagnosed with or without EGD. Methods We conducted a retrospective case-control study in two pediatric gastroenterology centers in Giessen and Marburg. CD patients presenting with high anti-TG2-IgA-antibodies (≥10× upper limit of normal) were included. Data were obtained from the routine medical documentation sheet at 0, 0.5, 1 and 2 years after diagnosis. Results 48 patients (24 patients per group) were included. Both groups did not differ in sex or age distribution, symptom burden, comorbidities, weight and BMI z-scores or routine laboratory parameters at baseline. Decline of anti-TG2-IgA-antibodies was similar in both groups. Serological remission was achieved in 6% (without EGD) and 16% (with EGD) at 0.5 years and 26% and 41% at 1 year after diagnosis with no significant differences between the two groups. Symptom relief, weight and BMI z-scores as well as hemoglobin, ferritin and mean corpuscular volume did not differ depending on the mode of diagnosis. Conclusion Our data confirm that the biopsy-sparing diagnostic algorithm is associated with similar serological and clinical outcomes in pediatric CD patients. Thus, our findings support the further application and implementation of the “non-biopsy approach.”