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Abstract
This prospective study investigates whether measurement of plasma intestinal-fatty acid binding protein (I-FABP), a sensitive marker for small intestinal epithelial damage, improves non-invasive diagnosing of celiac disease (CD), and whether I-FABP levels are useful to evaluate mucosal healing in patients on a gluten-free diet (GFD). Ninety children with elevated tTG-IgA titres and HLA-DQ2/DQ8 positivity were included (study group). Duodenal biopsies were taken, except in those fulfilling the ESPGHAN criteria. Plasma I-FABP levels and tTG-IgA titres were assessed sequentially during six months of follow-up. Eighty children with normal tTG-IgA titres served as control group. In 61/90 (67.8%) of the children in the study group an increased I-FABP level was found; in all these children CD diagnosis was confirmed. Interestingly, in 14/30 (46.7%) children with slightly elevated tTG-IgA titres (<10x upper limit of normal), an increased I-FABP level was found. In all these children the diagnosis of CD was confirmed histologically. After gluten elimination for six weeks I-FABP levels had decreased towards levels in the control group. Measurement of plasma I-FABP, in addition to tTG-IgA, EMA-IgA and HLAtyping, enables non-invasive diagnosing of CD in a substantial number of children, and might therefore be of value in the diagnostic approach of CD.
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Details
1 Department of Pediatrics & Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University Medical Centre, Maastricht, The Netherlands
2 Department of Pediatric Gastroenterology, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
3 Department of Pathology, Maastricht University Medical Centre, Maastricht, The Netherlands
4 Department of Pathology, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
5 Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
6 Department of General Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Neuroscience, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
7 Department of Pediatrics, Sint Anna Hospital, Geldrop, The Netherlands
8 Department of Pediatrics, VieCuri, Venlo, The Netherlands
9 Department of Pediatrics, Zuyderland, Sittard, The Netherlands
10 Department of Pediatrics, Laurentius Hospital, Roermond, The Netherlands
11 Department of Pediatrics, Sint Jans Gasthuis, Weert, The Netherlands
12 Department of Pediatrics, Zuyderland, Heerlen, The Netherlands
13 Department of Pediatrics, Amphia Hospital Breda, Weert, The Netherlands