Does Serum Anti-tissue Transglutaminase Level Predict Duodenal Histopathology and Clinical Manifestations of Celiac Disease in Adults?

BACKGROUND

Celiac disease (CD) is an autoimmune disorder triggered by gluten ingestion. This study aimed to evaluate the correlation between anti-tTG antibodies and histopathology, as classified by the Marsh system, and clinical manifestations.

METHODS

This retrospective cross-sectional study analyzed the records of 346 patients with confirmed CD from 2010 to 2021. Anti-tTG levels, clinical manifestations, body mass index (BMI), and pathological results were reviewed.

RESULTS

This study included 346 patients (mean age 26.5±16.6 years; 56.4% female). Most patients (53.2%) had atypical CD, and normal BMI was prevalent (57.1%). Common symptoms included anxiety (70.2%), fatigue/weakness (64.2%), borborygmi (53.2%), abdominal pain (51.2%), and bloating (46.8%). Disease severity analysis revealed 75.1% had Marsh III, while 15.9% had normal/Marsh I and 9.0% had Marsh II. Anti-tTG levels were significantly higher in advanced Marsh classes (Marsh III: 169.27±180.17 vs. normal/Marsh I: 70.94±116.45, P<0.001) and in typical CD (180.44±216.22) compared to atypical CD (126.20±121.72, P=0.005). Diarrhea, arthralgia, and osteoporosis/osteomalacia showed significant correlations with anti-tTG levels (P<0.05). ROC analysis for anti-tTG in diagnosing Marsh II or higher yielded an AUC of 0.733.

CONCLUSION

Anti-tTG demonstrated moderate diagnostic accuracy for advanced duodenal damage, highlighting its utility as a biomarker in CD. Larger studies are needed to validate these findings further.