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Is intestinal biopsy always needed for diagnosis of celiac disease?
Am J Gastroenterol 2003; 98(6):1325-31AJ

Abstract

OBJECTIVE

Intestinal biopsy is required for a diagnosis of celiac disease (CD). The aim of this study was to assess diagnostic accuracy of transglutaminase antibodies (TGA) in comparison and in association with that of antiemdomysial antibodies (AEA), calculating the post-test odds of having the disease, to verify whether some patients might avoid undergoing intestinal biopsy for a diagnosis of CD.

METHODS

A total of 181 consecutive patients (131 < 18 yr), referred to our celiac clinic by primary care physicians for suspect CD. Overall diagnostic accuracy, negative predictive value, and likelihood ratio (LR) were calculated both for each serological test and for serial testing (TGA and after AEA, assuming the post-test probability of TGA as pretest probability of AEA). Both serological determination and histological evaluation were blindly performed. Histology of duodenal mucosa was considered the gold standard.

RESULTS

The overall accuracy of TGA and of AEA were 92.8% (89.1-96.6) and 93.4% (89.7-97.0), respectively. The negative predictive value of TGA and AEA were 97.2% (91.9-102.6) and 87.2% (77.7-96.8), respectively. Positive likelihood ratios for TGA and AEA were 3.89 (3.40-4.38) and 7.48 (6.73-8.23), respectively. Serial testing, in groups of patients with prevalence of CD estimated higher than 75%, such as those with classic symptoms of CD, would provide a post-test probability of more than 99%.

CONCLUSIONS

Our results suggest that serial testing with TGA and AEA might allow, in some cases, the avoidance of intestinal biopsy to confirm the diagnosis of CD.

Authors+Show Affiliations

Department of Pediatrics, GI Unit, University of Messina, Messina, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

12818277

Citation

Scoglio, Riccardo, et al. "Is Intestinal Biopsy Always Needed for Diagnosis of Celiac Disease?" The American Journal of Gastroenterology, vol. 98, no. 6, 2003, pp. 1325-31.
Scoglio R, Di Pasquale G, Pagano G, et al. Is intestinal biopsy always needed for diagnosis of celiac disease? Am J Gastroenterol. 2003;98(6):1325-31.
Scoglio, R., Di Pasquale, G., Pagano, G., Lucanto, M. C., Magazzù, G., & Sferlazzas, C. (2003). Is intestinal biopsy always needed for diagnosis of celiac disease? The American Journal of Gastroenterology, 98(6), pp. 1325-31.
Scoglio R, et al. Is Intestinal Biopsy Always Needed for Diagnosis of Celiac Disease. Am J Gastroenterol. 2003;98(6):1325-31. PubMed PMID: 12818277.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is intestinal biopsy always needed for diagnosis of celiac disease? AU - Scoglio,Riccardo, AU - Di Pasquale,Giuseppe, AU - Pagano,Giuseppe, AU - Lucanto,Maria Cristina, AU - Magazzù,Giuseppe, AU - Sferlazzas,Concetta, PY - 2003/6/24/pubmed PY - 2003/8/6/medline PY - 2003/6/24/entrez SP - 1325 EP - 31 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 98 IS - 6 N2 - OBJECTIVE: Intestinal biopsy is required for a diagnosis of celiac disease (CD). The aim of this study was to assess diagnostic accuracy of transglutaminase antibodies (TGA) in comparison and in association with that of antiemdomysial antibodies (AEA), calculating the post-test odds of having the disease, to verify whether some patients might avoid undergoing intestinal biopsy for a diagnosis of CD. METHODS: A total of 181 consecutive patients (131 < 18 yr), referred to our celiac clinic by primary care physicians for suspect CD. Overall diagnostic accuracy, negative predictive value, and likelihood ratio (LR) were calculated both for each serological test and for serial testing (TGA and after AEA, assuming the post-test probability of TGA as pretest probability of AEA). Both serological determination and histological evaluation were blindly performed. Histology of duodenal mucosa was considered the gold standard. RESULTS: The overall accuracy of TGA and of AEA were 92.8% (89.1-96.6) and 93.4% (89.7-97.0), respectively. The negative predictive value of TGA and AEA were 97.2% (91.9-102.6) and 87.2% (77.7-96.8), respectively. Positive likelihood ratios for TGA and AEA were 3.89 (3.40-4.38) and 7.48 (6.73-8.23), respectively. Serial testing, in groups of patients with prevalence of CD estimated higher than 75%, such as those with classic symptoms of CD, would provide a post-test probability of more than 99%. CONCLUSIONS: Our results suggest that serial testing with TGA and AEA might allow, in some cases, the avoidance of intestinal biopsy to confirm the diagnosis of CD. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/12818277/Is_intestinal_biopsy_always_needed_for_diagnosis_of_celiac_disease L2 - http://Insights.ovid.com/pubmed?pmid=12818277 DB - PRIME DP - Unbound Medicine ER -