Isolated positive anti-gliadin immunoglobin-A antibody in children with gastrointestinal symptoms

Amac: Colyak hastal›¤› taramas›nda, anti-gliadin immunglobulin G ve A antikorlar›n›n kullan›m›, doku transglutaminaz ve endomisyal antikorlar›n daha yuksek olan duyarl›l›k ve ozgullu¤u nedeniyle giderek azalmaktad›r. Kan›tlanm›fl ve muhtemel colyak hastal›¤› olgula- r›nda, yuksek anti-gliadin immunglobulin A deerleri daha ciddi mukozal hasarla iliflkilidir. Cal›flman›n amac›, anti-gliadin immunglob- ulin A'n›n cocuklarda colyak hastal›¤› tan›s› konmas›nda klinik onemi olup olmad›¤›n› tespit etmektir. Gerec ve Yontem: Poliklinie kro- nik kusma, kar›n ar›s›, ishal veya kab›zl›k hikayesiyle baflvuran cocuklar, colyak hastal›¤› ac›s›ndan deerlendirildi. Serum doku transglu- taminaz ve anti-gliadin immunglobulin A duzeyleri, EL‹SA testiyle, endomisyal antikor immunoglobulin A ise indirek immunofloresans yon- temiyle tespit edildi. Anti-gliadin immunglobulin A sonucu pozitif olan cocuklar›n couna ileri tetkik olarak proksimal gastrointestinal bi- yopsi yap›ld›. Bulgular: Onalt› cocukta, izole anti-gliadin immunglobulin A pozitiflii (negatif doku transglutaminaz ve endomisyal anti- kor immunoglobulin A) saptand›. Sekiz tanesi erkekti (ortalama yafl, 9.7). Hicbirisinde immunoglobulin A yetmezlii yoktu. Onuc tanesin- den, ust endoskopi ile cok say›da ince barsak biyopsisi al›nd›. ‹ki hastada villoz atrofi ve intraepitelial lenfosit say›s›nda hafif art›fl (Marsh 3a) ile muhtemel colyak hastal›¤› tan›s› kondu. Bu iki hastada anti-gliadin immunglobulin A titresi 70 unitenin uzerindeydi. Sonuc: Doku transglutaminaz ve endomisyal antikor immunoglobulin A pozitiflii olmad›¤›nda, izole anti-gliadin immunglobulin A pozitiflii olmas› du- rumunda, colyak hastal›¤› tan›s› ihtimali duflunulmelidir. Bu latent colyak hastal›¤› veya gluten hipersenstivitesi gibi durumlarda olabile- cek non-spesifik bir durum olabilir. Bu cocuklarda uzun sureli klinik takip, tan›n›n kesinlefltirilmesi icin onerilmektedir. Anahtar kelimeler: ‹zole anti-gliadin immunglobulin A antikoru, negatif doku transglutaminaz ve endomisyal antikorlar›, colyak hastal›¤›; Marsh s›n›flamas›; gastrointestinal semptomlar, gluten hipersenstivitesi Background/aims: The use of immunoglobulin G and A anti-gliadin antibodies for celiac disease screening has decreased due to higher spe- cificity and sensitivity of tissue transglutaminase and endomysial antibodies. Greater values of immunoglobulin-A anti-gliadin antibody ha- ve been associated with more severe mucosal damage in proven and probable celiac disease patients. The aim of this study was to determine whether anti-gliadin antibody immunoglobulin A has any clinical importance in diagnosing celiac disease in children. Children with a chro- nic history of vomiting, abdominal pain, diarrhea, or constipation in the outpatient clinic were evaluated for celiac disease. Materials and Methods: Tissue transglutaminase and anti-gliadin antibody immunoglobulin A in serum were determined by ELISA test and endomysial antibodies immunoglobulin A by indirect immunofluorescence. Most of these children with isolated positive anti-gliadin antibody immunog- lobulin A were further evaluated by performing proximal gastrointestinal biopsies. Results: Sixteen children had isolated positive anti-glia- din antibody immunoglobulin A (negative tissue transglutaminase and endomysial antibodies immunoglobulin A). Eight were male (mean age: 9.7 years). None had immunoglobulin A deficiency. Thirteen underwent an upper endoscopy with multiple small bowel biopsies. Two pa- tients had villous atrophy and slightly increased intraepithelial lymphocytes (Marsh 3a), which could make the diagnosis of celiac disease li- kely. These two patients had high titers of anti-gliadin antibody immunoglobulin A above 70 Units. Conclusions: An isolated positive anti- gliadin antibody immunoglobulin A result in the absence of positive tissue transglutaminase and endomysial antibodies immunoglobulin A should raise the suspicion of the diagnosis of celiac disease. This could be a non-specific phenomenon that could be found in other gastroin- testinal conditions, latent celiac disease, or gluten hypersensitivity. A longitudinal clinical follow-up is recommended in these children to con- firm the diagnosis.