Advantages of anti‐endomysial evaluation in children with low titers of anti‐transglutaminase antibodies: A retrospective study

Diagnosing celiac disease (CD) via esophagogastroduodenoscopy (EGDS) is necessary when anti-transglutaminase (anti-TG) antibody levels are below 10× the upper limit of normal (ULN). This study evaluates patients with low anti-TG titers, particularly when endomysial antibodies (EMA) are negative. In this retrospective study (2022-2024), patients undergoing EGDS for suspected CD were grouped by EMA status: Group 1 (EMA negative) and Group 2 (EMA positive), with similar low anti-TG titers. Group 1 (N = 25) had a mean anti-TG titer of 1.86× ULN and villous atrophy (VA) in only 8% (2/25). Group 2 (N = 100) had VA in 35% (35/100), a 6.16-fold higher risk. Nonatrophic cases showed no significant histological and immunohistochemical differences. In conclusion, low-titer anti-TG with negative EMA indicates a low likelihood of VA. Most asymptomatic patients may not require immediate intervention but should be monitored. EGDS can be reserved to later stages if clinical suspicion persists.