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POOR CORRELATION BETWEEN ANTI-TTG IGG AND MUCOSAL RECOVERY IN THE IGA-DEFICIENT COELIAC

John Campion 1, Mustafa Alkadhim 1, Lijo Thomas 1, Valerie Byrnes 1

Affiliations

1 University Hospital Galway, Galway, Ireland

Summary

AI Generated

In IgA-deficient coeliac disease patients, decline in anti-TTG IgG following a gluten-free diet does not correlate with mucosal healing on duodenal histology.

In a retrospective study of 19 IgA-deficient coeliac disease patients, only 21.4% of those with normalised duodenal histology after gluten elimination had concurrent normalisation of anti-TTG IgG.
Among patients reporting adherence to a gluten-free diet, 40%, 25% and 25% normalized their IgG anti-TTG levels at 1, 3 and 5 years respectively.
The authors conclude that persistently positive IgG anti-TTG does not signify ongoing gluten ingestion and that histologic recovery can reassure physicians irrespective of anti-TTG titre.
This material is relevant to gastroenterologists managing IgA-deficient coeliac disease patients and interpreting anti-TTG IgG serology during follow-up.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Selective IgA deficiency occurs in 0.3% of the population but is observed in 3% of people with coeliac disease (CD). Measurement of anti-TTG IgG provides an alternative screening test to anti-TTG IgA in such a cohort. However there is a paucity of data regarding the correlation between the decline in the anti-TTG IgG levels and mucosal healing following initiation of a gluten-free diet in IgA-deficient coeliac disease.

Aims & Methods

We set out to:
(1) assess the rate of decline of anti-TTG IgG following gluten elimination in patients with IgA deficient coeliac disease and
(2) assess the correlation between anti-TTG IgG and mucosal healing following gluten elimination. IgA-deficient patients were identified retrospectively from the coeliac database. Clinical, laboratory and histologic data were retrieved from the electronic patient record (EPR) and patient symptoms were recorded from the contemporaneous clinical notes.

Results

19 patients with IgA-deficient CD were identified. Eight patients (42%) were male and 11 (58%) female. Median (IQR) age at diagnosis was 25 years (15, 39). Symptoms reported included bloating (34%), abdominal pain (21%), diarrhoea (21%) and fatigue (21%). Five patients (26%) had at least one other autoimmune condition. Three patients (15.7%) had normal tTG igG on first testing, having been diagnosed on the basis of duodenal biopsy at another centre. Of those who reported adherence to gluten free diet after diagnosis, 40%, 25% and 25% of IgA deficient coeliacs normalized their IgG anti-TTG levels at 1, 3 and 5 years respectively. Of those patients whose duodenal histology normalised after elimination of dietary gluten, only 21.4% had concurrent normalisation of anti-TTG IgG.

Conclusion

The decline in IgG anti-TTG following gluten elimination does not correlate with mucosal healing. IgA-deficient coeliacs can be reassured that a persistently positive IgG anti- TTG does not signify ongoing gluten ingestion and physicians can be reassured by histologic recovery in such patients irrespective of the anti-TTG titre.

Conference

UEG Week Copenhagen 2023

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

PP 03 Small intestinal (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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