Giulia Previtali, Italy
ASST Papa Giovanni XXIII Clinical chemistry laboratoryPresenter of 4 Presentations
ANTI TRANSGLUTAMINASE (TTG) ANTIBODIES COULD PREDICT THE DEVELOPMENT OF CELIAC DISEASE 5 YEARS BEFORE THE DIAGNOSIS
Abstract
Background and Aims
Celiac disease (CD) is an autoimmune disease characterized by duodenal damages after gluten exposure in genetically predisposed subjects. Guidelines suggest to perform anti-transglutaminase (tTG) and anti-endomysium (EMA) for CD diagnosis. Many clinical sign and symptoms, not only gastrointestinal, are associated to CD and gluten free diet is the only available therapy. The aim of this study is to evaluate the predictive value for CD development of tTG on a chemiluminescence platform (BioFlash®, Inova).
Methods
10614 patients were tested for tTG between June 2012 and December 2013 at the clinical chemistry laboratory of Papa Giovanni Hospital (Bergamo, Italy). 515 subjects were tTG positive and we follow them up for 5 years.
Results
203/515 (39.4%) patients were excluded: 190 patients were already CD diagnosed and 13 were lost at follow up. 270/312 (86.5%) patients were diagnosed after the first tTG test or within 5 years of follow up, 42/312 (13.5%) subjects do not receive a confirmed CD diagnosis (CD was excluded for 22 subjects, 20 patients were classified as potential CD). The median tTG values between the two groups were statistically different (342.7 CU vs 35.23 CU; p<0.0001). ROC analysis showed a 95.4% probability to receive a CD diagnosis within 5 years for tTG values over 68.8 CU, it increases to 99.4% for tTG values over 170.5 CU.
Conclusions
A tTG result above 170.5 CU could predict with a very high probability the development of CD within 5 years independently from the pre-test probability.
OLMESARTAN ENTEROPATHY DRESSED UP AS CELIAC DISEASE: A CASE REPORT
Abstract
Background and Aims
Olmesartan is an antihypertensive drug belonging to the angiotensin II receptor blocker class, widely used in clinical practice. In rare cases, olmesartan is responsable of a severe enteropathy, defined “sprue-like enteropathy” because its similarity with celiac disease (CD) and other enteropathy with malabsorption. We described four cases of olmesartan-related enteropathy, observed in the last months of 2019 in the “Adult Celiac Disease Surgery” of Papa Giovanni XXIII Hospital (Bergamo, Italy).
Methods
1) 68yo man, admitted to the medicine unit for weight loss (-20kg) and severe malabsorption; duodenal biopsy showed a partial villous atrophy with inflammatory infiltrate of CD3 (50/100 enterocytes) 2) 62y man, with progressively increased abdominal discomfort with watery diarrhea and moderate weight loss, duodenal biopsy with Marsh 2 and increased CD3 3) 65y female, with chronic diarrhea, moderate weight loss, multiple vitamin deficiencies and sideropenic anemia, duodenal biopsy with Marsh 2 and increased CD3 and 3) 71y man, with chronic diarrhea, sometimes with fecal incontinence of watery feces and duodenal biopsy with Marsh 1 and incresed CD3 (45/100 enterocytes)
Results
All patients was HLA DQ2/DQ8 positive; colonscopy and screening for celiac disease (anti transglutaminase, AGA and EMA) were repeatedly negative; all the other causes of enteropathy were excluded. In all the cases, the suspension of olmesartan resolved completely the symptomatology.
Conclusions
Olmesartan therapy is an uncommon cause of “sprue like enteropathy” and can give problems of differential diagnosis with CD; so, the patient's medical history is essential to avoid unnecessary investigations and reach a correct diagnosis.
CLINICAL STUDY OF APTIVA CELIAC DISEASE IGA AND IGG REAGENTS ON PATIENTS WITH BIOPSY RESULTS
Abstract
Background and Aims
Antibodies to tissue transglutaminase(tTG) and deamidated gliadin peptide(DGP) are important factors in diagnosis of celiac disease(CD). Increased anti-tTG IgA titers can be especially important, where a titer 10 times the upper limit of normal (>10xULN) may consider foregoing invasive intestinal biopsy in diagnosis of CD. This study aimed to compare the performance of the novel assays for tTG and DGP with the results of patients who underwent biopsy.
Methods
A total of 130 patients with suspicion of CD that underwent biopsy to confirm diagnosis were tested on Aptiva Celiac Disease IgA and IgG which utilizes a novel particle-based multi-analyte technology (PMAT, research-use-only, Inova Diagnostics, USA) and QUANTA Flash (QF) tTG and DGP IgA and IgG Reagents. Additionally, sixteen pediatric samples were tested on both Aptiva and QF
Results
59 of the 130 patients with suspicion of CD were confirmed after the biopsy. The results on the Aptiva Celiac Disease Reagents are summarized in the Table below. Of note, the one patient diagnosed with dermatitis herpetiformis was positive for QF and Aptiva tTG IgA. Of the 16 pediatric patients, all were positive for tTG IgA with results >10xULN.
Conclusions
Anti-tTG and DGP antibodies measured using the novel fully automated PMAT assay showed excellent clinical performance with high correlation to biopsy results and the QF Celiac Reagents. The tTG IgA results >10xULN in this pediatric study confirms the use of serological testing as part of the criteria (along with genetic testing and presence of anti-endomysial antibodies) for pediatric patients is an alternative to invasive biopsy.
MYOCARDIUM DAMAGE AND ANTI-MITOCHONDRIAL ANTIBODY (AMA): CASE REPORT OF THREE NEWBORN SIBLING
Abstract
Background and Aims
H.R. is 30 years old egyptian woman.
Methods
In Egypt, in 2013, her first son born at 30 weeks of gestation and died after 17 days for “heart disease” (no clinical information provided). In 2016, a daughter born at 34th week: after 9 days the little girl was transferred at Papa Giovanni XXIII hospital’s ICU due to severe respiratory failure with pancarditis and dilated cardiomyopathy. Only high titre AMA-M2 of maternal origin was found without liver alterations for both mother and daughter. The newborn girl, treated with high dose prednisone, recovered completely. In 2018 H.R. started a new pregnancy and beyond AMA-M2, she was found positive for anti Sp-100 antibodies but she showed no signs of cholangitis. At the end of that pregnancy (32 weeks) a low weight newborn girl was born: after two days the little girl showed premature ventricular contractions and repolarisation abnormalities; she was transfer at ICU for cardiac monitoring and treated also with low dose prednisone because, even in this case, she was positive for AMA-M2 and Sp-100 antibodies. She recovered completely after 15 days and showed no problems during the follow up: AMA-M2 antibodies became negative after 7 months.
Results
This case report suggests that AMA could have a role in the pathogenesis of cardiac abnormalities showed by the three siblings.
Conclusions
In literature association between AMA and autoimmune cardiomyopathy is described but only in adult patients: probably because AMA test is not performed in newborn with cardiomyopathy leading to an underestimation of AMA-associated cardiomyopathy cases.