{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T08:30:38Z","timestamp":1776673838056,"version":"3.51.2"},"reference-count":27,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T00:00:00Z","timestamp":1776556800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: The prerequisite for diagnosing celiac disease (CD) in children without duodenal biopsy is a tissue transglutaminase antibody (TGA) level exceeding 10 times the upper limit of normal levels, along with a positive confirmatory anti-endomysial antibody (EMA) test in a secondary blood sample. The aim of our study was to determine whether determination of TGA in a second blood sample could be as reliable as determination of EMA as the confirmatory test in children eligible for the no-biopsy approach. Methods: A retrospective analysis of medical data was conducted, including children under 19 years old who were diagnosed with coeliac disease at our department from January 2013 to June 2025. We examined the diagnostic process, focusing on TGA levels at the time of diagnosis. Results: Data from 185 CD patients (59.5% female, median age 8 years) were available for the analysis. 49 (26.5%) patients were diagnosed using no-biopsy approach and 46 (93.9%) of those had TGA &gt; 10 \u00d7 ULN in second blood sample as well. In the group of children diagnosed using duodenal biopsy (N = 136; 96.3% 3 Marsh), 78 (57.4%) children had initial TGA &gt; 10 \u00d7 ULN. In 34 (43.6%) of those children, secondary serology performed before introducing a diet showed that 30 (88.2%) of them had TGA &gt; 10 \u00d7 ULN. Conclusions: Our study suggests that TGA levels &gt; 10 \u00d7 ULN could serve as a reliable test for confirming the diagnosis of CD in children, eligible for the no-biopsy approach, thus making the diagnostic process more cost-effective and efficient, while maintaining accuracy.<\/jats:p>","DOI":"10.3390\/diagnostics16081216","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T07:15:08Z","timestamp":1776669308000},"page":"1216","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring Tissue Transglutaminase Antibodies as a Confirmatory Tool for Diagnosing Coeliac Disease in Children"],"prefix":"10.3390","volume":"16","author":[{"given":"Petra","family":"Riznik","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Gastroenterology, Hepatology and Nutrition Unit, University Medical Centre Maribor, 2000 Maribor, Slovenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricija","family":"Levstik","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mojca","family":"Kukovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8095-5592","authenticated-orcid":false,"given":"Jernej","family":"Dolinsek","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Gastroenterology, Hepatology and Nutrition Unit, University Medical Centre Maribor, 2000 Maribor, Slovenia"},{"name":"Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/S0140-6736(17)31796-8","article-title":"Coeliac disease","volume":"391","author":"Lebwohl","year":"2018","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/MPG.0000000000002497","article-title":"European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020","volume":"70","author":"Husby","year":"2020","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/j.cgh.2017.06.037","article-title":"Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis","volume":"16","author":"Singh","year":"2018","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1097\/MPG.0000000000002424","article-title":"Diagnostic Delays in Children with Coeliac Disease in the Central European Region","volume":"69","author":"Riznik","year":"2019","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1159\/000370204","article-title":"Clinical manifestations of celiac disease","volume":"33","author":"Green","year":"2015","journal-title":"Dig. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2413","DOI":"10.1016\/S0140-6736(22)00794-2","article-title":"Coeliac disease","volume":"399","author":"Catassi","year":"2022","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Mpakosi, A., Kaliouli-Antonopoulou, C., Cholevas, V., Cholevas, S., Tzouvelekis, I., Mironidou-Tzouveleki, M., Lianou, A., Iacovidou, N., Tsantes, A.G., and Sokou, R. (2025). Challenges in the Pediatric Celiac Disease Diagnosis: An Up-to-Date Review. Diagnostics, 15.","DOI":"10.3390\/diagnostics15182392"},{"key":"ref_8","first-page":"118","article-title":"The role of serology in the diagnosis of coeliac disease","volume":"16","author":"Volta","year":"2023","journal-title":"Gastroenterol. Hepatol. Bed Bench"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1136\/adc.54.10.783","article-title":"The diagnosis of coeliac disease. A commentary on the current practices of members of the European Society for Paediatric Gastroenterology and Nutrition (ESPGAN)","volume":"54","author":"McNeish","year":"1979","journal-title":"Arch. Dis. Child."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1136\/adc.65.8.909","article-title":"Revised criteria for diagnosis of coeliac disease. Report of Working Group of European Society of Paediatric Gastroenterology and Nutrition","volume":"65","author":"Guandalini","year":"1990","journal-title":"Arch. Dis. Child."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1097\/MPG.0b013e31821a23d0","article-title":"European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease","volume":"54","author":"Husby","year":"2012","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Yl\u00f6nen, V., Lindfors, K., Repo, M., Huhtala, H., Fuchs, V., Saavalainen, P., Musikka, A., Laurila, K., Kaukinen, K., and Kurppa, K. (2020). Non-Biopsy Serology-Based Diagnosis of Celiac Disease in Adults Is Accurate with Different Commercial Kits and Pre-Test Probabilities. Nutrients, 12.","DOI":"10.3390\/nu12092736"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1111\/jgh.16436","article-title":"Validation of no-biopsy pathway for the diagnosis of celiac disease in Asian adults: A multicenter retrospective study","volume":"39","author":"Pachisia","year":"2024","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_14","first-page":"270","article-title":"Beyond biopsy: Evaluating noninvasive techniques to diagnose celiac disease in adults","volume":"38","author":"Cauchi","year":"2025","journal-title":"Ann. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1053\/j.gastro.2023.12.023","article-title":"Accuracy of the No-Biopsy Approach for the Diagnosis of Celiac Disease in Adults: A Systematic Review and Meta-Analysis","volume":"166","author":"Shiha","year":"2024","journal-title":"Gastroenterology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.1002\/ueg2.70119","article-title":"European Society for the Study of Coeliac Disease 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 1: Diagnostic Approach","volume":"13","author":"Zingone","year":"2025","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1097\/MPG.0000000000001216","article-title":"NASPGHAN Clinical Report on the Diagnosis and Treatment of Gluten-related Disorders","volume":"63","author":"Hill","year":"2016","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e001900","DOI":"10.1136\/bmjgast-2025-001900","article-title":"Nationwide survey of coeliac disease serology testing in the UK","volume":"12","author":"Alex","year":"2025","journal-title":"BMJ Open Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"59","DOI":"10.14309\/ajg.0000000000002075","article-title":"American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease","volume":"118","author":"Hill","year":"2023","journal-title":"Am. J. Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1002\/jpn3.12383","article-title":"Endomysial antibodies or anti-tissue transglutaminase type 2 IgA antibodies as a confirmatory test in children with celiac disease","volume":"80","author":"Achler","year":"2025","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/archdischild-2013-303996","article-title":"Joint BSPGHAN and Coeliac UK guidelines for the diagnosis and management of coeliac disease in children","volume":"98","author":"Murch","year":"2013","journal-title":"Arch. Dis. Child."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1002\/jpn3.12382","article-title":"Tissue transglutaminase immunoglobulin A exceeds endomysial antibody in specificity of celiac diagnosis at \u226510 times the upper limit of normal","volume":"79","author":"Pacheco","year":"2024","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/j.pathol.2020.05.002","article-title":"Assessment of European Society of Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines in an Australian paediatric population","volume":"52","author":"Thompson","year":"2020","journal-title":"Pathology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1097\/MPG.0000000000003378","article-title":"Real-life Performance of Multiplex Celiac Antibody Test in the Diagnosis of Pediatric Celiac Disease","volume":"74","author":"Kori","year":"2022","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1111\/jpc.16801","article-title":"No-Biopsy Diagnosis of Coeliac Disease in Children Without Anti-Endomysial IgA Antibody Testing: Combining Anti-Tissue Transglutaminase IgA and Anti-Deamidated Gliadin IgG Antibodies","volume":"61","author":"Pumar","year":"2025","journal-title":"J. Paediatr. Child. Health"},{"key":"ref_26","first-page":"988","article-title":"\u201cPer ELISA\u201d: Time to adopt anti-transglutaminase\/deamidated gliadin peptide diagnostic combination in coeliac disease of adults?","volume":"56","author":"Rispo","year":"2024","journal-title":"Dig. Liver Dis. Off. J. Ital. Soc. Gastroenterol. Ital. Assoc. Study Liver"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s13052-023-01435-6","article-title":"Role of age in dynamics of autoantibodies in pediatric Celiac disease","volume":"49","author":"Trovato","year":"2023","journal-title":"Ital. J. Pediatr."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/8\/1216\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T07:33:08Z","timestamp":1776670388000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/8\/1216"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,19]]},"references-count":27,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["diagnostics16081216"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16081216","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,19]]}}}