Background: Celiac disease (CD) is the most prevalent food intolerance caused by genetics in the world.

Aim: To evaluate the validity of a feasible, noninvasive test, i.e., serum anti-tissue transglutaminase IgA antibodies as a diagnostic test for patients with CD, compared to the gold standard diagnostic test for such cases, i.e., intestinal biopsy histopathology.

Methods: This is a prospective observational study conducted at Gastroenterology Unit at Assiut University Children Hospital from December 2019 to November 2020. The study included 60 children who were suspected clinically to have CD. Serum level of antitissue transglutaminase IgA (tTGIgA) antibodies were analyzed by enzyme-linked immunosorbent assay (ELISA). Duodenal histopathology using gross endoscopic pictures and Marsh-Ober Huber criteria, were determined.

Results: Histological examination found 16 patients (26.7%) exhibited positive findings consistent with CD. Serological analysis showed that 14 patients (25%) had positive antibody results. The diagnostic performance of tTG-IgA was evaluated using the receiver operating characteristic (ROC) curve, yielding an area under the curve (AUC) of 0.81. The sensitivity of tTG-IgA was 87.7%, while the specificity was 97.7%. The positive predictive value (PPV) was calculated to be 75%, whereas the negative predictive value (NPV) was 98%, indicating a high level of diagnostic accuracy.

Conclusion: The study emphasized the clinical utility of tTG-IgA antibodies as a highly specific and reliable non-invasive diagnostic tool for identifying children at risk of CD. Early identification and appropriate management of CD through serological screening can significantly improve outcomes and quality of life for affected children.