Growing evidence supports the view that the diagnosis of celiac disease can be made by serological tests alone, although this approach is still not widely accepted.
Dr Geoffrey Holmes and colleagues previously showed in retrospective and prospective studies that in adults an IgA-tissue transglutaminase antibody cut-off can be defined above which the positive predictive value for celiac disease is 100%.
Following a change in the analytical method for measuring the antibody, the team re-examined this finding in a larger series of adults to ascertain whether a diagnosis of celiac disease can be reliably made in a proportion of patients without the need for small bowel biopsy.
The researchers also re-evaluated the diagnostic guidelines used in their center.
|An IgA-tissue transglutaminase antibody cut-off greater than 45 U/ml provided a positive predictive value of 100%|
|European Journal of Gastroenterology & Hepatology|
The team performed a retrospective analysis in an unselected series of 270 adult patients who had small bowel biopsies and serum IgA-tissue transglutaminase antibody levels measured from 2009 to 2014.
At an IgA-tissue transglutaminase antibody cut-off greater than 45 U/ml the positive predictive value for celiac disease in this cohort was 100%.
The researche team observed that 40% of cases were above this cut-off.
Dr Holmes' team concludes, "We have verified that a diagnosis of celiac disease can be reliably made in a high proportion of adults based on serology alone using the IgA-tissue transglutaminase antibody method specified."
"These results add to the body of evidence that small bowel biopsy should no longer be considered mandatory for the diagnosis of celiac disease."
"On the basis of these results the diagnostic guidelines in our center have been modified."