Severity Of Duodenal Histology And Tissue Transglutaminase Antibody Levels Correlate Well In Adult Celiac Disease Irrespective Of Clinical Features

Celiac disease (CD) is a chronic immune-mediated enteropathy that occurs in genetically predisposed individuals. The clinical phenotypes range from classical gastrointestinal manifestations to only atypical signs, thus being a challenge to diagnose. Aim: To investigate the relationship between duodenal histology, specific antibody levels and clinical presentation in adult Romanian CD patients. Material and methods: Study design: retrospective retrieval of information prospectively entered into a structured database including 81 adult patients diagnosed with CD admitted with symptoms of abdominal disturbances (diarrhea, heartburn, nausea, vomiting, regurgitation, abdominal pain) to the Iasi Institute of Gastroenterology and Hepatology, "Sf. Spiridon" Emergency Clinical County Hospital between January 2012 and December 2016. The demographic, clinical, serological, and histological characteristics of individuals with CD were reviewed. Results: The female: male ratio was 3: 1, 60 (71.1%) female patients, mean age 40.02 +/- 12.14 years. A total of 48.1% patients presented with gastrointestinal (GI) complaints and 51.9% presented mostly with non-GI manifestations, with a slightly more advanced age at symptom onset in the latter (38 yrs. vs. 47 yrs.). Marsh-Oberhuber classification was used to assess mucosal injury and Marsh 3c lesions were found in 25 (30.9%) cases. When assessing the serological parameters, IgA anti-tissue transglutaminase (IgA-tTG) antibody (61.45 +/- 76.458 u/mL vs. 162.02 +/- 106.179 u/mL, p=0.001) and IgA anti-gliadin antibody (IgA-AGA) levels (61.83 +/- 69.41u/mL vs. 77.15 +/- 71.02 u/mL, p=0.001) correlated with intestinal villous atrophy (Marsh 3a and 3c) in CD patients by Spearman rank correlation. Of the symptoms, abdominal distention and diarrhea were associated with abnormal histology. Hemoglobin levels were determined and anemia was diagnosed in 61.7% of the patients with elevated IgA-tTG levels (r=-0.316; p=0.004), IgA-AGA (r=-0.301; p=0.006) and Marsh 3b-3c lesions (p=0.0048). Of the biological markers included in the statistical analysis, low iron levels (cut off 30 mg/dl), hypocholesterolemia and low protein levels were associated with Marsh 3b lesions (p=0.006) and elevated tTG-IgA levels (r=-0.384; p=0.001). Conclusions: IgA-tTG and AGA levels correlate with duodenal villous atrophy in adult CD patients. An IgA-tTG level. 160 was nearly always associated with severe CD histopathology. GI and non-GI symptoms are not reliable predictors of CD.