Additional erroneous assumptions that led to improper management included: no referral because symptoms resolved, starting on a GFD with no follow-up testing to evaluate response to a gluten free diet, and individual refusal for further evaluation. or improper management. Results Of the 775 individuals having a positive TTG, 193 (24.9%, 95% CI 21.9C28.1%) received no follow-up management. We contacted 173 purchasing physicians and 120 (69%) responded. Of the 120 reactions, 55 individuals (45.8%, 95% CI 36.8C55.1%) were managed appropriately and 46 (38.3%, 95% CI 29.7C47.7%) were considered to be inappropriately managed when no repeat TTG was obtained within 18?weeks. Reasons Rabbit Polyclonal to LMO3 for improper management included: display considered to be false positive (44.7%), patient was not experiencing symptoms of celiac disease (31.6%), symptoms had resolved (15.8%), results were not indicative of celiac disease (26.3%) and individuals started a gluten-free diet ONO-7300243 with no evaluation of response (15.8%). In 19 individuals the TTG was not acted upon for technical reasons. Conclusions Positive TTGs require appropriate interventions. These include: subspecialist referral for further evaluation and/or repeat testing to evaluate: 1) treatment response or 2) individuals with minimal or no symptoms. Electronic supplementary material The online version of this article (10.1186/s12887-019-1621-5) contains supplementary material, which is available to authorized users. anti-endomysial antibody cells transglutaminase antibody top limit of normal The only statistical difference was between the appropriate & inappropriately handled individuals having a TTG??10 x ONO-7300243 ULN (9/101) versus the nonresponders having a TTG??10 x ULN (17/73) ( em p /em ? ?0.05) Of the 120 individuals with completed questionnaires, 55 (45.8%, 95% CI 36.8C55.1%) individuals were considered to be managed appropriately. This included either a repeat TTG within 18?weeks of the previously elevated TTG and/or referral for subspecialty evaluation for further management (Table ?(Table1,1, Additional file 2: Number S2). All the nine individuals having a TTG? ?3 x ULN and positive EMA were appropriately managed within four weeks (Additional file 2: Number S2). Of those having a moderately elevated TTG (3C10 x ULN), 8/15 were determined likely a false positive and the TTG was repeated a median 3.5?weeks later (range 2.5 to 15?weeks). The TTG returned to normal in six individuals or was only 1 1.5 x ULN in two. Of the 36 with a low TTG ( ?3 x ULN), four experienced known celiac disease, six were referred for subspecialty evaluation and 26 individuals had a repeat TTG a median of 6?weeks later (range 1C18?weeks). In 18 individuals, the TTG experienced normalized upon repeat testing. Of the 120 individuals, 46 (38.3%, 95% CI 29.7C47.7%) were managed inappropriately including 18 children who had a repeat TTG at least 3.5?years after the initial TTG and 28 children with no repeat TTG (Table ?(Table1).1). All five of the individuals having a TTG??10 x ULN started a GFD without right follow-up testing to assess response to a GFD (four individuals experienced no repeat ONO-7300243 TTG, one experienced a repeat TTG over 6?years later). Of the 10 individuals having a moderately elevated TTG (3C10 x ULN), only five experienced a repeat TTG (median 38?weeks later, range 21C50?weeks), while five had no repeat TTG and the purchasing physician did not feel the test was indicative of celiac disease based on the individuals symptoms. Two-thirds of inappropriately handled individuals (31/46) had a low TTG ( ?3 x ULN). Only 12 experienced a repeat TTG (median 37?weeks, range 25C83?weeks), of which four individuals had an increased TTG upon repeat testing. Nine individuals who refused GI evaluation did not have a repeat TTG. As physicians may take action more cautiously with more youthful individuals, we evaluated if the individuals age at initial TTG affected a physicians follow-up management. We characterized the appropriately and inappropriately handled individuals into two organizations: under six years of ONO-7300243 age ( em n /em ?=?26) and greater than six years ( em n /em ?=?75). Of the children less than six, 12/26 (46.1%; 95% CI 28.7C64.5%) were inappropriately managed, as ONO-7300243 compared to 34/75 (45.3%; 95% CI 34.6C56.6%) of those over six, as a result showing a similar proportion.