Abstract: Patients methods: clinical data from CD patients under 15 years old were collected from the participating centres in an on-line multicentre nationwide observational Spanish registry called REPAC-2 (2011-2017). Correlation between anti-tissue transglutaminase antibodies (t-TGA) levels and other variables, including mucosal damage and clinical findings (symptoms, age and gender), was assessed. Results: 2955 out of 4838 patients had t-TGA and a small bowel biopsy (SBB) performed for CD diagnosis. 1931 (66.2%) patients with normal IgA values had a Marsh 3b-c lesion and 1892 (64.9%) had t-TGA IgA ?10 times ULN (upper limit of normal).There is a statistically significant association between t-TG IgA levels and the degree of mucosal damage (p value < 0.001), the higher the t-TGA IgA levels the more severe the mucosal damage. Those patients who reported symptoms had more severe mucosal damage (p value 0.001). On the contrary there was a negative association between age and changes of the intestinal mucosa (p< 0.001). No association was found with gender.Regarding the IgA deficient patients, 47.4% (18 cases) had t-TGA IgG ?10 times ULN and a Marsh 3b-c lesion was observed in 68.4% (26 patients). No statistical relation was found between t-TGA IgG levels and the changes of the intestinal mucosa, neither a relation with age, gender or symptoms. Conclusion: There is a positive correlation between t-TGA IgA levels and the severity of changes of the intestinal mucosa. Such correlation was not found in IgA deficient patients who had positive t-TGA IgG serology. The results in this group of patients support the ESPGHAN recommendations about the need of performing a SBB in IgA deficient individuals despite high t-TGA IgG levels.

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