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Elevated Serum Tissue Transglutaminase Antibodies in Children With Eosinophilic Esophagitis.

OBJECTIVES: This study compared the clinical and histopathological characteristics of children with EoE and elevated anti-transglutaminase (TTG Ab) with those with EoE and normal TTG Ab titres.

METHODS: Single center chart and blinded histopathological review of patients diagnosed with EoE over a four-year period, who had esophageal and duodenal biopsies taken at time of endoscopy, and TTG Ab measured within 6 months of biopsy. Patients with histology-proven CD were excluded.

RESULTS: Elevated TTG Ab was present in 19/34 (54%) of the study cohort, representing 23% of all patients diagnosed with EoE during the study period. Eight had titers >6x upper limit of normal (ULN) and four had >10xULN. TTG Ab-positive patients were classified as having either potential CD with (n = 3; 16%) and without lymphocytic duodenosis (n = 12; 63%), and no CD (n = 4; 21%) on HLA typing. There was an increase in duodenal eosinophils in patients with elevated TTG Ab (p = 0.01), which remained when patients with lymphocytic duodenosis were excluded (p = 0.018). Of 19 patients with EoE and elevated TTG Ab, 5 responded to elimination diet involving exclusion of wheat, including two with a sole wheat trigger and TTG Ab >10xULN that were CD-associated HLA-negative.

CONCLUSIONS: Serum TTG Ab was elevated in almost a quarter of our total EoE cohort, and at least 20% of these patients did not have potential CD, suggesting EoE is a heterogeneous disease with differing immune mechanisms activated in some patients. These findings also support routine esophageal biopsy during upper endoscopy in children with elevated TTG Ab.

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