Scripties UMCG - Rijksuniversiteit Groningen
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The Value of Serum I-FABP in non-invasive diagnostics of celiac disease in patients with moderately elevated Ig-A anti-tTG levels

(2017) Oldenburger, I.B.

Background Current diagnostic guidelines for celiac disease (CD) still require a duodenal biopsy
in patients with IgA anti-tissue transglutaminase levels (tTG) <10x the upper limit of normal
(ULN). The search is on for markers that may enable a non-invasive diagnosis in this group of
patients. Serum intestinal fatty acid binding protein (I-FABP), a marker for intestinal epithelial
damage, may provide this.
Aim Examine if I-FABP may provide a non-invasive diagnosis in patients with a tTG 1-10x
Methods A total of 95 children with a clinical suspicion of CD and tTG 1-10x ULN were
included. All underwent a duodenal biopsy within 3 months after their blood sample was taken.
Serum I-FABP levels were determined retrospectively. As a control group served 161 children
diagnosed with familial short stature or constitutional growth delay, all with normal tTG.
Results Serum I-FABP in all 95 patients with a tTG 1-10x ULN (median 650 pg/ml) was
significantly (P <0.0001) higher than in controls (median 263 pg/ml). I-FABP levels in the 71
patients with tTG 1-10x ULN with biopsy proven CD (median 725 pg/ml) were also significantly
different (P<0.0001) from controls (median 263 pg/ml), but did not differ significantly (P=0.13)
from levels in the 24 patients with a tTG 1-10x ULN but a normal biopsy (median 497 pg/ml).
Analysis of the use of I-FABP in subgroups based on tTG levels resulted in no falsely diagnosed
patients if tTG is 5-10x ULN and I-FABP≥ 880 pg/ml. Indeed, out of 24 patients with a tTG 5-
10x ULN all 11 patients with I-FABP ≥880 pg/ml had histologically proven CD. Analysis of
patients with tTG <5x ULN did not provide any relevant cut-offs for I-FABP.
Conclusion Addition of I-FABP to the diagnostic procedure of CD may provide a non-invasive
diagnosis in part of the patients with a tTG 5-10x ULN.

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