Normalization of Anti Tissue Trans-glutaminase Antibodies in Patients with Histologically Confirmed Celiac Disease: A Retrospective Analysis

Author(s):

Jawa H, Khatib H*, Almani I, Etaiwi A, Alharbi A, Ajaj A, Alsahafi M, Bokhary R, Mosli M and Qari Y

Background: Frequent absence from classes may lead to improper learning and poor academic performance. Absenteeism can make teaching - learning environment unwelcoming and impacting those also who attend classes regularly.

Patients and Methods: We conducted a retrospective analysis of all patients diagnosed with celiac disease based on histological criteria between 2013 and 2018 at King Abdulaziz University Hospital (KAUH). Baseline patient demographics, clinical, endoscopic, histological and follow up data was ascertained from the hospitals’ electronic medical records. The main primary outcome of interest was rate of and time to normalization of anti TTG antibodies. Logistic and Cox proportional regression analysis were used to identify predictors of the main outcome. Odds Ratio (ORs) and Hazard Ratios (HR) with 95% confidence intervals (95% CI) were generated.

Results: Seventy-six patients fulfilled the study criteria. Average age was 30.5 (± 12) years. Females comprised 58% of the cohort and 54% were Saudis. The most common presentation was anemia (46%) followed by abdominal pain (28%). Dermatitis herpetiformus was reported in 13%. While selective IgA deficiency was documented in 13%, other autoimmune diseases were noted in 32%. Mean anti TTG at baseline was 217 ± 457 IU/ml. Iron deficiency, vitamin B12 deficiency, and Folate deficiency were reported in 49%, 11%, and 11%, respectively. Osteopenia and Osteoprosis according to DEXA scan were found in 22.4% and 22.4%, respectively. Villous atrophy was reported in 74% (mild to moderate in 39% and severe in 47%) of biopsy samples. Mean follow up was 43.8 (± 35.1) months. Overall, anti TTG antibody normalization was achieved in 46% of patients. Anti TTG antibody concentration was less likely to normalize in the presence of villous atrophy (OR=0.50, 95%=0.26-0.95, p=0.03). Time to normalization was predicted by Folate deficiency (HR=14.30, 95% CI=1.88-108.68, p=0.01), osteoporosis (HR=0.07, 95% CI=0.009-0.51, p=0.009), and a positive Rheumatoid Factor (RF) (HR= 5731.3, 95% CI=34.69-946852, p=0.001).

Conclusion: A significant proportion of patients diagnosed with celiac disease achieve normalization of previously documented high anti TTG antibody concentrations. Folate deficiency and osteoporosis are predictive of biochemical remission.