Although in children with higher anti-transglutaminase (TGA-IgA) titres, the algorithm of the diagnosis of celiac disease (CD) is well known, it is a clinical challenge to handle children with low TGA-IgA levels. The study aimed at identifying the diagnostic usefulness in the prediction of CDs in children of chronically low positive TGA-IgA titers. They examined children who were not eligible for the no-biopsy approach retrospectively, and had symptoms or signs of CD. Youngsters were included for at least 2 TGA-IgA, EMA and esophagogastroduodenoscopy with biopsies. Multiples of ULN values of TGA-IgA were provided. The median TGA-IgA values of patients were divided into groups: A, B, and C. There were analysed data of 281 children. CDs were diagnosed in 142 of the 162 group A children, while 20 were identified with standard duodenal mucosa. Group B diagnoses of CD were made to all 62 children. Group C comprised 57 checks. In 31 cases of mucosal atrophy, EMA was undetectable. A mean value of 1.7 ULN exhibited 81.4 percent sensitivity and 81.8 percent specificity in the receptor characteristic curve to anticipate mucosal harm.

Good indicators of a CD Diagnosis are repeated low or moderate value TGA-IgA. Esophagogastroduodenoscopy should be carried out for symptomatic children with persistently low positive TGA-IgA titers regardless of their EMA status.