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Aliment Pharmacol Ther. 2019 Feb;49(3):277-284. doi: 10.1111/apt.15109. Epub 2018 Dec 27.

Serology-based criteria for adult coeliac disease have excellent accuracy across the range of pre-test probabilities.

Author information

1
Celiac Disease Research Center, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
2
Tampere Center for Child Health Research, University of Tampere, and Department of Paediatrics, Tampere University Hospital, Tampere, Finland.
3
Tampere Faculty of Social Sciences, University of Tampere, Tampere, Finland.
4
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.
5
Department of Dermatology, Tampere University Hospital, Tampere, Finland.
6
Department of Neurology, Päijät-Häme Central Hospital, Lahti, Finland.
7
Research Programs Unit, Immunobiology, and Haartman Institute, Department of Medical Genetics, University of Helsinki, Helsinki, Finland.
8
Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.

Abstract

BACKGROUND:

The revised paediatric criteria for coeliac disease allow omission of duodenal biopsies in symptomatic children who have specific serology and coeliac disease-associated genetics. It remains unclear whether this approach is also applicable for adults with various clinical presentations.

AIM:

To evaluate the accuracy of serology-based criteria in adults with variable pre-test probabilities for coeliac disease.

METHODS:

Three study cohorts comprised adults with high-risk clinical coeliac disease suspicion (n = 421), moderate-risk family members of coeliac disease patients (n = 2357), and low-risk subjects from the general population (n = 2722). Serological and clinical data were collected, and "triple criteria" for coeliac disease comprised transglutaminase 2 antibodies >10× the upper limit of normal, positive endomysium antibodies, and appropriate genetics without requirement of symptoms. The diagnosis was based on intestinal biopsy.

RESULTS:

The diagnosis of coeliac disease was established in 274 subjects. Of these, 59 high-risk subjects, 17 moderate-risk subjects, and 14 low-risk subjects fulfilled the "triple criteria". All had histologically proven coeliac disease, giving the criteria a positive predictive value of 100%. Altogether, 90 (33%) of all 274 newly diagnosed patients could have avoided biopsy, including 37% among high-risk, 20% among moderate-risk, and 48% among low-risk patients. No histological findings other than coeliac disease were found in the biopsies of "triple positive" subjects.

CONCLUSIONS:

Coeliac disease can reliably and safely be diagnosed without biopsy in adults fulfilling the "triple criteria" regardless of the pre-test probability. Revised criteria would enable the number of endoscopies to be reduced by one-third.

PMID:
30592070
DOI:
10.1111/apt.15109

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