Researchers have found that high levels of serum anti-tissue transglutaminase IgA (tTG-IgA) can predict duodenal villous atrophy, potentially serving as a reliable measure to bypass biopsy in diagnosing adult patients with suspected celiac disease. Here are the main points:
Background: The prevalence and incidence of celiac disease (CeD) are on the rise globally. Traditional diagnosis involves specific serology and an intestinal biopsy. However, the accuracy of gluten-specific serology is high, while histology, which requires upper endoscopy, remains operator-dependent.
Study Details: In a multicenter prospective study involving 436 adults suspected of having celiac disease, the accuracy of serum tTG-IgA as a non-biopsy diagnostic strategy was assessed. The diagnosis was defined by duodenal villous atrophy.
Results: Positive serum tTG-IgA was detected in 83% of participants. Of these, 341 had positive histology (true positives), while 22 had negative histology (false positives). The positive predictive value of serum testing was 93.9%. High levels of tTG-IgA could predict intestinal damage, suggesting that a biopsy might be avoided in diagnosing CeD in adult patients with a high pretest probability.
Implications: The study suggests a potential simplification in the diagnostic process for adult patients suspected of having CeD. Eliminating the need for a duodenal biopsy could lead to significant savings in terms of time, cost, risk, and patient discomfort.
Recommendations: While the accuracy of the anti-tTG-IgA antibodies test was found to be excellent across all international centers, there’s a need for test standardization and defining the range of normality. The no-biopsy strategy should be used by centers highly familiar with CeD and its implications.