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News

Testing patients on presentation for serologic features of celiac disease

A study in the latest issue of Clinical Gastroenterology & Hepatology evaluates the utility of testing patients, on presentation, for serologic features of celiac disease.

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Celiac disease shares features of other disorders.

It can be diagnosed conclusively only based on duodenal histology analysis, which is not practical for screening purposes.

Serologic analysis might be used to identify candidates for biopsy analysis.

Dr Karna Dev Bardhan and colleagues from the United Kingdom developed a simple diagnostic approach that all clinicians could follow to increase the percentage of patients accurately diagnosed with celiac disease at initial presentation.

The team performed a retrospective analysis of data from 752 patients who attended a UK district general hospital from 2007 through 2008 and underwent biopsy analysis and serologic tests to measure endomyseal antibodies and IgA antibodies against tissue transglutaminase (tTG).

Patients avoiding gluten in their diet were excluded.

Patients were assigned to 1 of 4 groups, including high-risk, low-risk, nutrient deficiency, or screening.

Patients with celiac disease were identified using the modified Marsh criteria for interpreting duodenal histology.

The research team compared clinical category, serology profiles, and biopsy results between patients with and without celiac disease.

The team diagnosed celiac disease in 11% of the high-risk group, 9% in the low-risk group, 25% in the nutrient-deficiency group, and all of the patients in the screening group.

Among 71 patients who tested positive for both antibodies, the positive predictive value for celiac disease was 97%.

The researchers found that a negative test result for tTG had a negative predictive value of 98%.

Among 708 patients with normal-looking biopsy samples, only 9% had celiac disease.

The team observed that among 44 patients with abnormal biopsy samples, 59% had celiac disease.

Dr Bardhan's team concludes, "Based on a retrospective analysis, patients with and without celiac disease cannot be distinguished based on clinical features."

"Patients who present with symptoms of celiac disease should be tested for tTG, to identify candidates for duodenal biopsy analysis."

Clin Gastroenterol Hepatol 2014: 12(6): 946–952
30 May 2014

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