Influence of Age and Type 1 Diabetes Mellitus on Serological Test for Celiac Disease in Children

Pediatr Gastroenterol Hepatol Nutr. 2021 Mar;24(2):218-229. doi: 10.5223/pghn.2021.24.2.218.Epub 2021 Mar 4.

Anshu Maheshwari 1 2 3, Zhaoping He 1 2, Melissa Nicole Weidner 1 2 4, Patrick Lin 1 2 5, Ryan Bober 2 6, Fernando J Del Rosario 1 2


Author information

  • 1Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
  • 2Department of Pediatrics, Sidney Kimmel College of Medicine, Philadelphia, PA, USA.
  • 3Department of Pediatrics, University of Illinois College of Medicine in Peoria and Children's Hospital of Illinois, Peoria, IL, USA.
  • 4Department of Pediatrics, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.
  • 5Department of Pediatrics, Lehigh Valley Reilly Children's Hospital, Allentown, PA, USA.
  • 6Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA.


Purpose: Serological tests of tissue transglutaminase (TTG) and deamidated gliadin (DGP) antibodies for celiac disease diagnosis show conflicting correlation with histology in young children and in type 1 diabetes mellitus (T1DM). Tests' ability to predict histology and cutoff values based on age and T1DM was evaluated.

Methods: A retrospective study of children who had celiac serological tests between 6/1/2002 and 12/31/2014 at a pediatric hospital.

Results: TTG IgA displayed similar results in predicting histology between <4.0 and ≥4.0 years age groups with sensitivity 98% and 93%, and specificity 88% and 86%, respectively. In children <4.0 years old, sensitivity for DGP antibodies was 100% and specificity 94%; in ≥4.0 years age groups, sensitivity was 60%, 88% for DGP IgA and IgG and specificity 95%, 96%, respectively. TTG IgA had low specificity in patients with T1DM compared with non-T1DM, 42% vs. 91%. Positive TTG IgA with normal histology was associated with higher T1DM prevalence at 36% compared with negative tests at 4%. Finally, the TTG IgA cutoff value was higher in T1DM at 36 vs. 16.3 units in non-T1DM. DGP IgG cutoff showed similar values between age groups; TTG IgA and DGP IgA cutoffs were lower in <4.0 years at 8.3 and 11.9 units than ≥4.0 years at 23.4 and 19.9, respectively.

Conclusion: TTG IgA is sufficient for the <4.0 years age group and DGP antibodies had no advantage over TTG IgA in older children. The cutoff value to determine a positive TTG IgA should be higher for children with T1DM.

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