Anita Rao, MD, Meredith McIntee, APN, Meghan Landry, MPH, Ritu Verma, MBChB University of Chicago, Chicago, IL
Introduction: It is generally agreed upon that abnormally elevated Celiac Disease (CD) serologies are a reliable marker for duodenal mucosal damage. AGA and ESPGHAN guidelines allow the option to forgo biopsies in patients who are positive for HLA DQ2/DQ8 with sufficiently elevated serology. NASPGHAN recommends confirmation of diagnosis via duodenal biopsy in all patients. Progress toward mucosal healing is typically monitored by CD serology, but there has been disagreement regarding whether normalized serology can be considered a reliable marker for intestinal healing after following a gluten-free diet.
Methods: IRB-approved chart review was conducted at University of Chicago on patients < 21 years with CD who had undergone follow up EGD after CD diagnosis. Biopsy results were correlated with serologies including TTG IgA, DGP IgA, DGP IgG, or EMA, as well as demographics and other clinical data. Data were analyzed using independent sample t-tests and Wilcoxon Mann-Whitney U tests in SPSS.
Results: 69 patients (41% female, 51% male) with a mean age of 9.5 years at diagnosis were eligible. 65 patients (94.2%) were diagnosed with CD by biopsy and serologies. 4 of 69 (5.8%) were diagnosed by serologies alone. 151 follow-up EGDs were performed, and 94 had repeat CD serologies done at the time of EGD. Indications included persistent symptoms on a GFD (15), elevated serologies (43), other GI condition (75), gluten challenge (8), and other (10). Patients with any elevated serologies were significantly more likely to have villous blunting (t=2.750, p< 0.001), increased IELs (t=2.189, p< 0.001), and crypt hyperplasia (t=1.560, p=0.001). Elevated TTG IgA and DGP IgA were associated with the presence of villous blunting (U=112, p< 0.001, and U=66.5, p=0.031 respectively), but elevated DGP IgG was not (U=71, p=0.174). 22 of the 43 with elevated serology (51.2%) had normal duodenal biopsies.
Discussion: A strong correlation exists between elevated CD serologies and degree of mucosal injury. CD patients who have elevated serologies should have more than one type drawn, especially if the only indication for repeat EGD is mildly elevated serology. However, of the 43 patients with elevated CD serologies who underwent repeat EGD, 22 (51.2%) had normal biopsies (Marsh 0). Although CD serologies have been considered a surrogate for mucosal healing, the findings indicate that there may be more specific clinical or serologic data that could better represent ongoing enteropathy.
Anita Rao indicated no relevant financial relationships.
Meredith McIntee indicated no relevant financial relationships.
Meghan Landry indicated no relevant financial relationships.
Ritu Verma indicated no relevant financial relationships.
Anita Rao, MD, Meredith McIntee, APN, Meghan Landry, MPH, Ritu Verma, MBChB. P0887 - Follow-Up Esophagogastroduodenoscopy in Pediatric Celiac Disease Patients, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.