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Results: This study included 346 patients (mean age 26.5\u00b116.6 years; 56.4% female). Most patients (53.2%) had atypical CD, and normal BMI was prevalent (57.1%). Common symptoms included anxiety (70.2%), fatigue\/weakness (64.2%), borborygmi (53.2%), abdominal pain (51.2%), and bloating (46.8%). Disease severity analysis revealed 75.1% had Marsh III, while 15.9% had normal\/Marsh I and 9.0% had Marsh II. Anti-tTG levels were significantly higher in advanced Marsh classes (Marsh III: 169.27\u00b1180.17 vs. normal\/Marsh I: 70.94\u00b1116.45, P&lt;0.001) and in typical CD (180.44\u00b1216.22) compared to atypical CD (126.20\u00b1121.72, P=0.005). Diarrhea, arthralgia, and osteoporosis\/osteomalacia showed significant correlations with anti-tTG levels (P&lt;0.05). ROC analysis for anti-tTG in diagnosing Marsh II or higher yielded an AUC of 0.733. Conclusion: Anti-tTG demonstrated moderate diagnostic accuracy for advanced duodenal damage, highlighting its utility as a biomarker in CD. Larger studies are needed to validate these findings further.<\/jats:p>","DOI":"10.34172\/mejdd.2025.429","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T20:30:55Z","timestamp":1765657855000},"page":"183-189","update-policy":"https:\/\/doi.org\/10.34172\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Does Serum Anti-tissue Transglutaminase Level Predict Duodenal Histopathology and Clinical Manifestations of Celiac Disease in Adults?"],"prefix":"10.34172","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2843-9977","authenticated-orcid":true,"given":"Reza","family":"Gholamrezaei","sequence":"first","affiliation":[{"name":"Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atefeh","family":"Vaezi","sequence":"additional","affiliation":[{"name":"Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatemeh","family":"Maghool","sequence":"additional","affiliation":[{"name":"Poursina Hakim Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nahid","family":"Jamali","sequence":"additional","affiliation":[{"name":"School of Health Management and Information Science, Iran University of Medical Sciences, Tehran, Iran"},{"name":"Iranian Celiac Association (ICA), Isfahan, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0318-0081","authenticated-orcid":true,"given":"Mohammad Hassan","family":"Emami","sequence":"additional","affiliation":[{"name":"Poursina Hakim Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"20123","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(17)31796-8"},{"key":"R2","doi-asserted-by":"crossref","unstructured":"Singh P, Arora A, Strand TA, Leffler DA, Catassi C, Green PH, et al. 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