Time to normalisation of tissue transglutaminase in paediatric coeliac disease is dependent on initial titre and half of patients will normalise within 12 months

Abstract

Background: Coeliac disease (CD) is common. Response to a gluten-free diet is assessed through serial measurement of tissue transglutaminase (TTG) antibody titre. However, the relationship of TTG titres to symptoms and the speed of normalisation is poorly understood.

Methods: Patients seen in 2020, and under follow-up in the Southampton CD clinic, had blood results, growth measures and symptom data collated. Time to normalisation, predictors of normalisation and relationship of TTG to growth/symptoms were assessed.

Results: 57 patients were included. All had TTG results from the time of diagnosis and follow-up. All families reported dietary compliance.Median TTG at diagnosis was 100 μ/L (range 0.3-4360), 94.7% of the patients had symptoms compatible with CD. At 6-12 months after diagnosis, the median TTG was 3.8 μ/mL (range 0.3-133). In terms of response, 29 of the 57 patients (50.9%) had a TTG below 4 μ/mL (upper normal limit). A further 25 patients (43.9%) had a TTG<10 times the upper limit of normal. Ten patients (17.5%) had a persistently high TTG (median=8.55 μ/mL, range 4.1-303) after >12 months.TTG at diagnosis was correlated with TTG at 6-12 months, β=0.542, p=0.000016. Patients with TTG<10 times the upper limit of normal at diagnosis group were more likely to have normalised at 6-12 months compared with >10 times normal (85% vs 32.4%, p=0.0015). TTG titres did not correlate with growth measures (Z-scores) at diagnosis or at follow-up.

Conclusions: Normalisation of TTG levels occurs within 6-12 months for around half of patients. Higher TTG levels at diagnosis take longer to normalise. The role of compliance is unclear.

Keywords: gastroenterology; paediatrics.