Non-invasive Test Diagnoses Celiac Disease Without Biopsy in Some Patients
A non-invasive test can accurately diagnose celiac disease in some patients and could lead to a decreased need for endoscopic diagnostic tests in the population, according to research published in Alimentary Pharmacology & Therapeutics.
Kalle Kurppa, MD, PhD, of the University of Tampere in Finland, and colleagues wrote patients that fit a “triple criteria” — transglutaminase 2 antibodies more than 10 times the upper limit of normal, positive endomysium antibodies, and celiac genotype — can be diagnosed with a serology test regardless of their pre-test probability of celiac disease.
“There is increasing evidence to support the accuracy of these guidelines for pediatric celiac disease if applied meticulously,” they wrote. “Whether the non-biopsy approach could be applicable also in adult celiac disease remains controversial.”
To assess the reliability of the serology test, researchers recruited three study cohorts; adults with high-risk clinical celiac disease suspicion (n = 421), moderate-risk family members of patients with celiac disease (n = 2,357) and low-risk individuals from the general population. They collected serum samples to determine which patients fit the “triple criteria.”
Investigators diagnosed 274 patients with celiac disease using intestinal biopsy. Ninety patients (59 high-risk, 17 moderate-risk and 14 low-risk patients) fit the “triple criteria.” All were diagnosed with histologically proven disease, giving the serology test a predictive value of 100%.
Fuchs and colleagues wrote that the test worked well regardless of the presence of apparent symptoms, which could prove beneficial in a disease where recognizing symptoms can be difficult.
“Definition of symptoms and their association with celiac disease are challenging, as the clinical and histological presentation may not correlate and symptoms can fluctuate or not be recognized until their alleviation on a glutenfree diet,” they wrote. “Applying such serologybased approach would lead to substantially reduced number of endoscopies and subsequent health care savings without affecting the diagnostic accuracy.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.