ASSOCIATION BETWEEN CLINICAL FEATURES, IGA TISSUE TRANSGLUTAMINASE ANTIBODY, AND HISTOLOGICAL FINDINGS IN CELIAC DISEASE

Abstract

Background: Celiac disease (CD) is an immune-driven disorder of the intestine that develops in genetically predisposed individuals after consuming gluten. It manifests with diverse gastrointestinal and extra-intestinal features. Diagnosis relies on a combination of serology and histology, with IgA tissue transglutaminase (tTG-IgA) serving as a key biomarker and Marsh classification grading the severity of mucosal damage. However, limited data exist from Pakistan on the correlation between clinical features, serological markers, and histopathological changes.

Objective: To determine the frequency of clinical presentations, IgA tTG antibody levels, and histopathology findings in Celiac Disease patients, and to assess the associations between them.

Methods: We conducted a cross-sectional study in Department of Medicine of Pak Emirates Military Hospital (PEMH), Rawalpindi, Pakistan during June 2025 and September 2025, after enrolling a total of 139 patients aged 14–60 years with positive IgA tTG using non-probability consecutive sampling. Clinical features were documented through history and examination, tTG-IgA levels were measured using ELISA, and duodenal biopsies were scored as per Marsh classification. Chi-square/Fisher’s exact tests were applied for associations using SPSS 27.

Results: Median age of the participants was 35 years, with 54.7% males. Impaired growth (36%), chronic diarrhea (33.1%), muscle wasting (21.6%), and anemia (34.5%) were the most frequent clinical features. Tissue transglutaminase IgA was positive in 91.4% of patients, with 41% weak positive, 48.9% moderate positive, and 1.4% strong positive. Histologically, most patients exhibited Marsh I–III changes. No significant association was observed between Marsh classification and clinical features, whereas a strong correlation was found between Marsh stage and both tTG-IgA positivity and antibody levels (p < 0.01).

Conclusion: CD in our population presents with varied clinical and nutritional features, but histological severity is more closely linked with serological markers than with symptoms. These findings highlight the diagnostic value of tTG-IgA in predicting mucosal damage and emphasize the need for integrated serological and histological assessment in clinical practice.