Celiac disease is a condition in which the immune system responds abnormally to a protein
called gluten , and leads to many gastrointestinal and systemic effects . There are four categories of
celiac disease : (classical, atypical, silent and laten
t) . The diagnosis of celiac disease is established
by a combination of the history , physical examination , serological tests , upper endoscopy results
and multiple biopsies of the duodenum .
This research is designed to study the correlation between the titres of Anti TTg IgA and
between the severity of histological changes in the biopsy , and to study the correlation between the
severity of clinical manifestations and between the degree of villous atrophy . The study included
the adult patients who presented to Al-Assad University Hospital and Tishreen University Hospital
during the period 2015- 2016 . We measured Anti tTG IgA titers . when the results were positive,
patients went to upper endoscopy with duodenal biopsies . The diagnosis of celiac disease was
made on the base of positive antibodies and the presence of duodenal biopsy of Marsh ≥ 2 .
The results : 79 patients had positive IgA Anti tTG , and they had duodenal biopsies , the
diagnosis of celiac disease was made in 71 of them . The celiac disease was found in % 89.873 of
the study group .
We found no correlation between the titers of Anti TTg IgA and between sex or age. The
clinical manifestations varied , iron deficiency anemia was the most common (%49.3) and
abdominal pain (%39.4) . Also, we found no correlation between the titers of Anti tTG IgA and
between the severity of clinical manifestations or laboratory results . There was no correlation
between the degree of histological damage and between the severity of clinical manifestations .
We noticed that histological injury had progressed whenever the titers of Anti tTG IgA had raised
. We were able to determine the titer of Anti tTG IgA in which it was diagnostic for celiac disease
without the need for duodenal biopsies with sensitivity of 80.3% and specificity equivalent to
100% and this titer was : (the upper limit of the laboratory's normal serum value multiplied by
11.35). We have reached that mild enteropathy in celiac disease is a serious problem that requires
strict adherence to a free gluten diet in order to prevent from the complications of the disease .
Several appearances were assigned in duodenum during endoscopy in patients with celiac disease, this study was conducted to determine the diagnostic value of some endoscopic markers in celiac patients in order to be used in the clinical diagnosis of
the disease an additional factor supporting the diagnosis. The study included 504 children reviewed the different symptoms (failure to thrive, chronic diarrhea or constipation, unexplained anemia, weight loss), and underwent an upper gastrointestinal endoscopy. Four markers were evaluated in the second and third part of the duodenum are: scalloping, reduction of duodenal folds, nodular mucosal pattern, and chronic inflammation (punctate whitish spots) . Celiac disease was diagnosed at 123 patients, which was based on the result of the pathology biopsy taken during endoscopy, the patients ranged in age from 6 months to 15 years. Scalloping was the highest sensitivity and specificity marker of 89% ,96 % respectively. Diagnostic values for these signs in general ( 91% sensitivity, 76% specific, positive predictive value 56 %, and negative predictive value 97% ). We observed that the presence of celiac disease, as well as histological grade rating by Marsh classification respect to the existence of endoscopic markers.
