J Pediatr Gastroenterol Nutr. 2025 Nov 27. doi: 10.1002/jpn3.70265. Online ahead of print.
ABSTRACT
OBJECTIVE: Celiac disease (CeD) is a chronic autoimmune condition triggered by gluten consumption. CeD is screened for using total serum immunoglobulin A (IgA) and tissue transglutaminase immunoglobulin A antibodies (tTG IgA Ab). This study aimed to evaluate IgA patterns over time in patients diagnosed with CeD during childhood.
METHODS: A retrospective chart review was performed at Lucile Packard Children’s Hospital (January 2012-December 2023). Patients diagnosed before 18 years of age with biopsy-confirmed CeD or those who met ESPGHAN nonbiopsy diagnostic criteria were included. Total serum IgA and tTG IgA Ab levels were required at diagnosis and two subsequent time points. Patients with missing data were excluded.
RESULTS: Of 1861 identified patients, 365 met study criteria. The average age at diagnosis was 9 years old, with an average follow-up time of 5 years. Sixteen patients (4.4%) were IgA insufficient at diagnosis; 11 (69%) remained insufficient while five (31%) became sufficient over the observation period. Nineteen patients (5.2%) initially identified as IgA sufficient developed IgA insufficiency.
CONCLUSIONS: IgA levels can fluctuate over time and should be monitored routinely to assess IgA sufficiency and ensure reliable tTG IgA Ab levels. Patients who regain IgA sufficiency can transition to tTG IgA Ab testing, allowing for more reliable assessments of mucosal healing and reducing the need for invasive procedures.
PMID:41307150 | DOI:10.1002/jpn3.70265
