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PA21 ANTIBODIES AGAINST SYNTHETIC DEAMIDATED GLIADIN PEPTIDES FOR THE DIAGNOSIS OF CHILDHOOD CELIAC DISEASE: DO THEY PLAY A ROLE?
S350
XVII National Congress SIGENP Abstracts / Digestive and Liver Disease 42S (2010), S321–S376
PA21 ANTIBODIES AGAINST SYNTHETIC DEAMIDATED GLIADIN PEPTIDES FOR THE DIAGNOSIS OF CHILDHOOD CELIAC DISEASE: DO THEY PLAY A ROLE?
CD and in 1/13 of controls; AdGA-IgG were positive in 58/78 of CD pts, in 3/11 of potential CD and in 0/13 of controls. Sensibility, specificity, NPV and PPV of AdGA and of tTG-Ab are shown in Table 1. Table 1
G.M. Tronconi a , B. Parma b , E. Bazzigaluppi c , P. Corsin a , G. Barera a
tTG-IgA
tTG-IgG
AdGA-IgA
AdGA-IgG
96.2% 58.3% 82.4% 88.2%
97.4% 70.8% 89.5% 91.6%
66.7% 87.5% 44.7% 51.2%
74.4% 87.5% 51.2% 95.1%
a Department
Sensitivity Specificity NPV PPV
Objectives: Previous studies have described the high sensitivity and specificity of antibodies against synthetic deamidated gliadin peptides (AdGA) in celiac disease (CD) patients (pts). The aims of this study are to confirm the sensibility, specificity, negative and positive predictive value (NPV, PPV) of AdGA and to verify the correlation of AdGA with anti tissue transglutaminase antibodies (tTG-Ab) in pts investigated for CD. Materials and methods: IgA and IgG AdGA were tested by an enzymelinked immunoabsorbent assay (Kit Inova Diagnostic). IgA and IgG tTG-Ab were measured by radio-binding assay. The histological study was done according to the Marsh’s classification modified by Oberhuber (M/O). Patients: 102 pts (62 F, 40 M, age M±SD: 7±4 ys) were studied by upper endoscopic biopsy for gastrointestinal symptoms or for suspected CD: n=78 → CD (typical lesions) n=11 → potential CD (positive tTG-Ab and DQ2/DQ8, normal histology) n=13 → gastrointestinal control (normal histology, negative tTG-Ab) Results: (1) AdGA-IgA were positive in 52/78 of CD pts, in 2/11 of potential
(2) The coefficient of determination (R2 ) was 0.19 and 0.23 for AdGAIgA/tTG-IgA and AdGA-IgG/tTG-IgG respectively (Figures 1 and 2). (3) 12 CD pts resulted positive to tTG IgA and/or IgG, but not to AdGA determinations; these pts would have been lost if AdGA alone were used for screening test. Conclusions: Our data show a lower sensitivity, NPV and PPV for AdGA, compared with tTG-Ab. The correlation between AdGA and tTG-Ab is poor. These results suggest that tTG-Ab are still pivotal for CD screening strategy.
of Pediatrics, Scientific Institute H. San Raffaele, Vita-Salute University, Milan; b Department of Pediatrics, Sant’Anna H., Como; c Diagnostica e Ricerca San Raffaele s.p.a. LaboRaf, Scientific Institute H. San Raffaele, Vita-Salute University, Milan
Figure 1
Figure 2
PA22 AN ATYPICAL COXALGIA: CASE REPORT L. Menni a , S. Tambini a , D. Alberti b , L. Migliazza b , G.F. Rondanini a a U.O.C.
Neonatologia, Pediatria e Adolescentologia Ospedale Civile di Vimercate, Italy; b U.O. Chirurgia Pediatrica Ospedali Riuniti di Bergamo, Italy Introduction: Coxalgia in children is a frequent symptom, which may be caused by an infectious, inflammatory, haematologic disease, transient osteoporosis, trauma, congenital hip dysplasia. Coeliac disease (CD) is a frequent autoimmune disease that can begin with atypical extraintestinal symptoms such as iron deficiency anaemia, short stature, osteopenia/osteoporosis, chronic liver disease, herpetiformis dermatitis, enamel hypoplasia, ataxia, hypertransaminasemia, recurrent aphthae, peripheral neuropathy. Among these complications osteopenia appears to be among the least frequent in children. In CD there is a greater risk of intestinal intussusception. Case report: 2 years and 6 months old Girl comes under our observation having suffered since approximately one month of left coxalgia, at first suffering of inconsistent lameness at the left leg and, after an accident and following injury, refusing to walk. The case history reports slow weight gain during the last year with weight loss of approximately 10% in the last two months; diet scarcely variegated based on milk and biscuits. Blood analysis show microcytic anemia rheumatologic and serological examinations, ultrasound of the hips and x-rays of the pelvis, femur and left knee all result within standard values (negative for focal lesions and fractures); furthermore it is performed an abdominal ultrasound that shows the presence of two pseudoespansive formations within left mesogastrial compatible with a twist or partial bowel intussusception, confirmed by the CT abdomen. At the Operative Unit of Pediatric Surgery of the Ospedali Riuniti of Bergamo, an exploratory laparoscopy visualizes double small bowel intussusception; consequentely manual de-intussusception and classic appendicectomy is performed by a laparotomic surgery. The postoperative course is characterized by deterioration of clinical conditions with persistent left coxalgia and progressive deterioration of the use of both lower limbs. It is therefore reassessed the diagnosis by repeating the immunorheumatologic/orthopedic analysis and extending the evaluations in search of malabsorption or tumors. The x-ray of the pelvis and hip showed signs of significant widely spread bone demineralization in the absence of bone’s structure injury; pelvis and femur MRI shows outcome of fractures resulting from a deficiency of bone demineralization. Screening for coeliac disease is therefore performed with positive outcome, with presence of HLA DQ2, the duodenal-jejunal biopsy shows a 3c type lesion according to Marsh. The gluten-free diet is therefore begun with supportive therapy of active metabolite of vitamin D, calcium, folic acid, vitamin D and iron iv bolus resulting in progressive clinical improvement. After approximately 3 months
XVII National Congress SIGENP Abstracts / Digestive and Liver Disease 42S (2010), S321–S376
PA21 ANTIBODIES AGAINST SYNTHETIC DEAMIDATED GLIADIN PEPTIDES FOR THE DIAGNOSIS OF CHILDHOOD CELIAC DISEASE: DO THEY PLAY A ROLE?
CD and in 1/13 of controls; AdGA-IgG were positive in 58/78 of CD pts, in 3/11 of potential CD and in 0/13 of controls. Sensibility, specificity, NPV and PPV of AdGA and of tTG-Ab are shown in Table 1. Table 1
G.M. Tronconi a , B. Parma b , E. Bazzigaluppi c , P. Corsin a , G. Barera a
tTG-IgA
tTG-IgG
AdGA-IgA
AdGA-IgG
96.2% 58.3% 82.4% 88.2%
97.4% 70.8% 89.5% 91.6%
66.7% 87.5% 44.7% 51.2%
74.4% 87.5% 51.2% 95.1%
a Department
Sensitivity Specificity NPV PPV
Objectives: Previous studies have described the high sensitivity and specificity of antibodies against synthetic deamidated gliadin peptides (AdGA) in celiac disease (CD) patients (pts). The aims of this study are to confirm the sensibility, specificity, negative and positive predictive value (NPV, PPV) of AdGA and to verify the correlation of AdGA with anti tissue transglutaminase antibodies (tTG-Ab) in pts investigated for CD. Materials and methods: IgA and IgG AdGA were tested by an enzymelinked immunoabsorbent assay (Kit Inova Diagnostic). IgA and IgG tTG-Ab were measured by radio-binding assay. The histological study was done according to the Marsh’s classification modified by Oberhuber (M/O). Patients: 102 pts (62 F, 40 M, age M±SD: 7±4 ys) were studied by upper endoscopic biopsy for gastrointestinal symptoms or for suspected CD: n=78 → CD (typical lesions) n=11 → potential CD (positive tTG-Ab and DQ2/DQ8, normal histology) n=13 → gastrointestinal control (normal histology, negative tTG-Ab) Results: (1) AdGA-IgA were positive in 52/78 of CD pts, in 2/11 of potential
(2) The coefficient of determination (R2 ) was 0.19 and 0.23 for AdGAIgA/tTG-IgA and AdGA-IgG/tTG-IgG respectively (Figures 1 and 2). (3) 12 CD pts resulted positive to tTG IgA and/or IgG, but not to AdGA determinations; these pts would have been lost if AdGA alone were used for screening test. Conclusions: Our data show a lower sensitivity, NPV and PPV for AdGA, compared with tTG-Ab. The correlation between AdGA and tTG-Ab is poor. These results suggest that tTG-Ab are still pivotal for CD screening strategy.
of Pediatrics, Scientific Institute H. San Raffaele, Vita-Salute University, Milan; b Department of Pediatrics, Sant’Anna H., Como; c Diagnostica e Ricerca San Raffaele s.p.a. LaboRaf, Scientific Institute H. San Raffaele, Vita-Salute University, Milan
Figure 1
Figure 2
PA22 AN ATYPICAL COXALGIA: CASE REPORT L. Menni a , S. Tambini a , D. Alberti b , L. Migliazza b , G.F. Rondanini a a U.O.C.
Neonatologia, Pediatria e Adolescentologia Ospedale Civile di Vimercate, Italy; b U.O. Chirurgia Pediatrica Ospedali Riuniti di Bergamo, Italy Introduction: Coxalgia in children is a frequent symptom, which may be caused by an infectious, inflammatory, haematologic disease, transient osteoporosis, trauma, congenital hip dysplasia. Coeliac disease (CD) is a frequent autoimmune disease that can begin with atypical extraintestinal symptoms such as iron deficiency anaemia, short stature, osteopenia/osteoporosis, chronic liver disease, herpetiformis dermatitis, enamel hypoplasia, ataxia, hypertransaminasemia, recurrent aphthae, peripheral neuropathy. Among these complications osteopenia appears to be among the least frequent in children. In CD there is a greater risk of intestinal intussusception. Case report: 2 years and 6 months old Girl comes under our observation having suffered since approximately one month of left coxalgia, at first suffering of inconsistent lameness at the left leg and, after an accident and following injury, refusing to walk. The case history reports slow weight gain during the last year with weight loss of approximately 10% in the last two months; diet scarcely variegated based on milk and biscuits. Blood analysis show microcytic anemia rheumatologic and serological examinations, ultrasound of the hips and x-rays of the pelvis, femur and left knee all result within standard values (negative for focal lesions and fractures); furthermore it is performed an abdominal ultrasound that shows the presence of two pseudoespansive formations within left mesogastrial compatible with a twist or partial bowel intussusception, confirmed by the CT abdomen. At the Operative Unit of Pediatric Surgery of the Ospedali Riuniti of Bergamo, an exploratory laparoscopy visualizes double small bowel intussusception; consequentely manual de-intussusception and classic appendicectomy is performed by a laparotomic surgery. The postoperative course is characterized by deterioration of clinical conditions with persistent left coxalgia and progressive deterioration of the use of both lower limbs. It is therefore reassessed the diagnosis by repeating the immunorheumatologic/orthopedic analysis and extending the evaluations in search of malabsorption or tumors. The x-ray of the pelvis and hip showed signs of significant widely spread bone demineralization in the absence of bone’s structure injury; pelvis and femur MRI shows outcome of fractures resulting from a deficiency of bone demineralization. Screening for coeliac disease is therefore performed with positive outcome, with presence of HLA DQ2, the duodenal-jejunal biopsy shows a 3c type lesion according to Marsh. The gluten-free diet is therefore begun with supportive therapy of active metabolite of vitamin D, calcium, folic acid, vitamin D and iron iv bolus resulting in progressive clinical improvement. After approximately 3 months