Screening for antibodies against transglutaminase type 2 (TG2A) at 6 years of age could advance the diagnosis of celiac disease in children, according to data published in the Journal of Gastroenterology.

Michelle Jansen, from the University Medical Center in Rotterdam, the Netherlands, and colleagues conducted a population-based cohort study to assess whether TG2A levels could predict subclinical celiac disease in a population of healthy children. They screened a total of 4,442 children (median age, 6.0 years) for serum TG2A, and 60 children with positive TG2A (1.4%) were invited for clinical evaluation.

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The researchers assessed medical history, physical examination, serum TG2A, and IgA endomysium (EMA). The children were also genotyped for HLA DQ2.2, DQ2.5, and DQ8. The participants who had positive serologies and genetic risk types underwent duodenal biopsies, and the TG2A levels at the time of the biopsy were compared with the degree of enteropathy.

Results showed that 60.8% of children had celiac disease, 19.6% did not have celiac disease, and 19.6% were considered potential celiac disease cases due to inconclusive serologies. The investigators observed celiac disease with Marsh 3a/b enteropathy in 75% of children with TG2A levels ≥10 ULN at 6 years of age and in 75% of children with a positive TG2A levels <10 ULN (odds ratio, 1.00).

The investigators also found that children with celiac disease had a lower BMI SDS (mean, -0.49) than children without celiac disease (mean, 0.47), and there were no observed differences in gastrointestinal symptoms.

“Our results indicate that the majority of asymptomatic 6-year-old TG2A-positive children developed subclinical CD [celiac disease] within 3 years following screening,” the study authors concluded.

“We did not find a positive association between serum TG2A concentrations and the degree of enteropathy. Thus, TG2A screening at 6 years of age could substantially advance CD diagnosis as children with subclinical CD in our study only showed a small deviation in height and weight, and lacked gastrointestinal symptoms.”


  1. Jansen M, van Zelm M, Groeneweg M, et al. The identification of celiac disease in asymptomatic children: the Generation R Study. J Gastroenterol. 2017. doi:10.1007/s00535-017-1354-x