Dr Andrew Hopper and colleagues from England assessed the effectiveness of detecting celiac disease in patients referred for gastroscopy without performing routine duodenal biopsy.
The team retrospectively analyzed a cohort of 2000 patients attending for gastroscopy.
The research team derived a clinical decision tool that could increase the detection of celiac disease without performing routine duodenal biopsy.
|The clinical decision tool had a sensitivity of 100%|
|British Medical Journal|
The tool incorporated serology, or measuring antibodies to tissue transglutaminase.
In addition, the team stratified patients according to their referral symptoms.
The patients were classified as having a ‘high risk' or ‘low risk' of celiac disease.
The team's decision tool was then tested on a second cohort of patients attending for gastroscopy.
In the second cohort all patients had a routine duodenal biopsy and serology performed.
The researchers found that no cases of celiac disease were missed by the pre-endoscopy testing algorithm.
The prevalence of celiac disease in patients attending for endoscopy was 4%.
The prevalence in the high risk and low risk groups was 10% and less than 1%, respectively.
The team noted that the prevalence of celiac disease in patients who were negative for tissue transglutaminase antibody was less than 1%.
The sensitivity, and specificity for a positive antibody result to diagnose celiac disease was 91% each.
The researchers observed that the positive predictive value of such a test was 29%.
The negative predictive value for a positive antibody result to diagnose celiac disease was just under 100%.
Evaluation of the clinical decision tool gave a sensitivity and specificity of 100% and 61%, respectively.
The team found that the positive predictive value of the clinical decision tool was 9%.
The researchers noted that the negative predictive value of the clinical decision tool was 100%.
Dr Hopperand's team concluded, “Pre-endoscopy serological testing in combination with biopsy of high risk cases detected all cases of coeliac disease.”
“The use of this decision tool may enable the endoscopist to target patients who need a duodenal biopsy.”