Testing for IgA anti-tissue transglutaminase in routine clinical practice: Requesting behaviour in relation to prevalence of positive results
Objective: Due to the high awareness of coeliac disease and improvement of serological tests, the number of requested laboratory tests has increased substantially over the years. In the current study we have evaluated the requesting behaviour of distinct clinical disciplines in relation to the preva...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-01-01
|
| Series: | Journal of Translational Autoimmunity |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589909020300125 |
| _version_ | 1818727625758081024 |
|---|---|
| author | Maurits Damoiseaux William van Doorn Ellen van Lochem Jan Damoiseaux |
| author_facet | Maurits Damoiseaux William van Doorn Ellen van Lochem Jan Damoiseaux |
| author_sort | Maurits Damoiseaux |
| collection | DOAJ |
| description | Objective: Due to the high awareness of coeliac disease and improvement of serological tests, the number of requested laboratory tests has increased substantially over the years. In the current study we have evaluated the requesting behaviour of distinct clinical disciplines in relation to the prevalence of positive results and in the context of existing guidelines. Methods: Data were retrospectively extracted from the laboratory information system over a time-span of 5 years in a tertiary hospital and compared with the situation in a secondary hospital. Results: Data reveal that for initial testing (n=18,183) the percentage positive results for IgA anti-TTG is <2%. Paediatricians have a slightly higher percentage of seropositive results (2.4–4.0%). Early confirmation (<2 months) of positive results by IgA anti-endomysium antibodies in an independent sample is only performed in a minority of paediatric patients. The majority of positive patients, however, have follow-up measurements (<14 months) in order to examine compliance to a gluten-free diet. Interestingly, initial requests for paediatric patients reveal an equal distribution between boys and girls, while in adult patients there is a two times preponderance of requests in female patients, similar to the female/male ratio in patients with positive results, being either paediatric or adult patients. Conclusion: Although laboratory testing for coeliac disease may be primarily used to exclude the disease, it is evident that the percentage positive results for IgA anti-TTG is extremely low. This may indicate that the clinical manifestations that warrant testing, should be further specified in order to increase the pre-test probability. As the specific serology is important to bypass a biopsy in the diagnosis of coeliac disease according to the paediatric guideline, the confirmation in an independent sample needs to get more attention. |
| first_indexed | 2024-12-17T22:17:05Z |
| format | Article |
| id | doaj.art-a786349485ab491f83dd556216f8bb1a |
| institution | Directory Open Access Journal |
| issn | 2589-9090 |
| language | English |
| last_indexed | 2024-12-17T22:17:05Z |
| publishDate | 2020-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Translational Autoimmunity |
| spelling | doaj.art-a786349485ab491f83dd556216f8bb1a2022-12-21T21:30:35ZengElsevierJournal of Translational Autoimmunity2589-90902020-01-013100045Testing for IgA anti-tissue transglutaminase in routine clinical practice: Requesting behaviour in relation to prevalence of positive resultsMaurits Damoiseaux0William van Doorn1Ellen van Lochem2Jan Damoiseaux3Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the NetherlandsCentral Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the NetherlandsDepartment of Microbiology and Immunology, Rijnstate Hospital, Arnhem, the NetherlandsCentral Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands; Corresponding author. Central Diagnostic Laboratory, Maastricht University Medical Center, P. Debyelaan 25, 6229HX, Maastricht, the Netherlands.Objective: Due to the high awareness of coeliac disease and improvement of serological tests, the number of requested laboratory tests has increased substantially over the years. In the current study we have evaluated the requesting behaviour of distinct clinical disciplines in relation to the prevalence of positive results and in the context of existing guidelines. Methods: Data were retrospectively extracted from the laboratory information system over a time-span of 5 years in a tertiary hospital and compared with the situation in a secondary hospital. Results: Data reveal that for initial testing (n=18,183) the percentage positive results for IgA anti-TTG is <2%. Paediatricians have a slightly higher percentage of seropositive results (2.4–4.0%). Early confirmation (<2 months) of positive results by IgA anti-endomysium antibodies in an independent sample is only performed in a minority of paediatric patients. The majority of positive patients, however, have follow-up measurements (<14 months) in order to examine compliance to a gluten-free diet. Interestingly, initial requests for paediatric patients reveal an equal distribution between boys and girls, while in adult patients there is a two times preponderance of requests in female patients, similar to the female/male ratio in patients with positive results, being either paediatric or adult patients. Conclusion: Although laboratory testing for coeliac disease may be primarily used to exclude the disease, it is evident that the percentage positive results for IgA anti-TTG is extremely low. This may indicate that the clinical manifestations that warrant testing, should be further specified in order to increase the pre-test probability. As the specific serology is important to bypass a biopsy in the diagnosis of coeliac disease according to the paediatric guideline, the confirmation in an independent sample needs to get more attention.http://www.sciencedirect.com/science/article/pii/S2589909020300125Coeliac diseaseSerologyDiagnostic criteria |
| spellingShingle | Maurits Damoiseaux William van Doorn Ellen van Lochem Jan Damoiseaux Testing for IgA anti-tissue transglutaminase in routine clinical practice: Requesting behaviour in relation to prevalence of positive results Journal of Translational Autoimmunity Coeliac disease Serology Diagnostic criteria |
| title | Testing for IgA anti-tissue transglutaminase in routine clinical practice: Requesting behaviour in relation to prevalence of positive results |
| title_full | Testing for IgA anti-tissue transglutaminase in routine clinical practice: Requesting behaviour in relation to prevalence of positive results |
| title_fullStr | Testing for IgA anti-tissue transglutaminase in routine clinical practice: Requesting behaviour in relation to prevalence of positive results |
| title_full_unstemmed | Testing for IgA anti-tissue transglutaminase in routine clinical practice: Requesting behaviour in relation to prevalence of positive results |
| title_short | Testing for IgA anti-tissue transglutaminase in routine clinical practice: Requesting behaviour in relation to prevalence of positive results |
| title_sort | testing for iga anti tissue transglutaminase in routine clinical practice requesting behaviour in relation to prevalence of positive results |
| topic | Coeliac disease Serology Diagnostic criteria |
| url | http://www.sciencedirect.com/science/article/pii/S2589909020300125 |
| work_keys_str_mv | AT mauritsdamoiseaux testingforigaantitissuetransglutaminaseinroutineclinicalpracticerequestingbehaviourinrelationtoprevalenceofpositiveresults AT williamvandoorn testingforigaantitissuetransglutaminaseinroutineclinicalpracticerequestingbehaviourinrelationtoprevalenceofpositiveresults AT ellenvanlochem testingforigaantitissuetransglutaminaseinroutineclinicalpracticerequestingbehaviourinrelationtoprevalenceofpositiveresults AT jandamoiseaux testingforigaantitissuetransglutaminaseinroutineclinicalpracticerequestingbehaviourinrelationtoprevalenceofpositiveresults |