Advantages of anti‐endomisium 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.