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What is the role of serologic testing in celiac disease? A prospective, biopsy-confirmed study with economic analysis.
Clin Gastroenterol Hepatol. 2008 Mar; 6(3):314-20.CG

Abstract

BACKGROUND & AIMS

The optimal serologic tests for the detection of celiac disease and follow-up assessment remains controversial. Our aim was to evaluate all current immunologic assays for diagnosing celiac disease using the gold standard of duodenal biopsy. We also assessed whether tissue transglutaminase (tTG) antibody is a quantitative marker for histologic severity.

METHODS

Consecutive adult patients referred for gastroscopy without a previous known diagnosis of celiac disease were recruited (group 1). Concurrently, patients with a known diagnosis of celiac disease on a gluten-free diet for more than 1 year undergoing repeat duodenal biopsy were identified (group 2). All patients had duodenal biopsies and serologic analysis performed for immunoglobulin(Ig) A and antibodies to human immunoglobulin (Ig)A-tTG, IgA-gliadin, IgG-gliadin, and IgA-endomysial antibody.

RESULTS

Two thousand patients were recruited in the first group. Seventy-seven (3.9%) patients were diagnosed with new celiac disease. The sensitivity, specificity, positive predictive value, and negative predictive value for IgA tTG were 90.9%, 90.9%, 28.6%, and 99.6%. When adopting a 2-step approach using tTG first and then EMA the sensitivity, specificity, positive predictive value, and negative predictive value was 85.7%, 98.6%, 71.7%, and 99.7%, respectively. The use of nondeamidated IgA/IgG gliadin antibodies conferred no additional diagnostic benefit when considering the detection of adult celiac disease. In the second group 48 patients with celiac disease on a gluten-free diet were identified. Sixteen of 48 of these patients had persisting villous atrophy, but 7 of 16 (44%) had a normal tTG level.

CONCLUSIONS

IgA tTG alone is a sensitive marker for celiac disease. A normal tTG level does not predict recovery of villous atrophy in patients with celiac disease on a gluten-free diet.

Authors+Show Affiliations

Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18328437

Citation

Hopper, Andrew D., et al. "What Is the Role of Serologic Testing in Celiac Disease? a Prospective, Biopsy-confirmed Study With Economic Analysis." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 6, no. 3, 2008, pp. 314-20.
Hopper AD, Hadjivassiliou M, Hurlstone DP, et al. What is the role of serologic testing in celiac disease? A prospective, biopsy-confirmed study with economic analysis. Clin Gastroenterol Hepatol. 2008;6(3):314-20.
Hopper, A. D., Hadjivassiliou, M., Hurlstone, D. P., Lobo, A. J., McAlindon, M. E., Egner, W., Wild, G., & Sanders, D. S. (2008). What is the role of serologic testing in celiac disease? A prospective, biopsy-confirmed study with economic analysis. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 6(3), 314-20. https://doi.org/10.1016/j.cgh.2007.12.008
Hopper AD, et al. What Is the Role of Serologic Testing in Celiac Disease? a Prospective, Biopsy-confirmed Study With Economic Analysis. Clin Gastroenterol Hepatol. 2008;6(3):314-20. PubMed PMID: 18328437.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - What is the role of serologic testing in celiac disease? A prospective, biopsy-confirmed study with economic analysis. AU - Hopper,Andrew D, AU - Hadjivassiliou,Marios, AU - Hurlstone,David P, AU - Lobo,Alan J, AU - McAlindon,Mark E, AU - Egner,William, AU - Wild,Graeme, AU - Sanders,David S, PY - 2008/3/11/pubmed PY - 2008/4/18/medline PY - 2008/3/11/entrez SP - 314 EP - 20 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 6 IS - 3 N2 - BACKGROUND & AIMS: The optimal serologic tests for the detection of celiac disease and follow-up assessment remains controversial. Our aim was to evaluate all current immunologic assays for diagnosing celiac disease using the gold standard of duodenal biopsy. We also assessed whether tissue transglutaminase (tTG) antibody is a quantitative marker for histologic severity. METHODS: Consecutive adult patients referred for gastroscopy without a previous known diagnosis of celiac disease were recruited (group 1). Concurrently, patients with a known diagnosis of celiac disease on a gluten-free diet for more than 1 year undergoing repeat duodenal biopsy were identified (group 2). All patients had duodenal biopsies and serologic analysis performed for immunoglobulin(Ig) A and antibodies to human immunoglobulin (Ig)A-tTG, IgA-gliadin, IgG-gliadin, and IgA-endomysial antibody. RESULTS: Two thousand patients were recruited in the first group. Seventy-seven (3.9%) patients were diagnosed with new celiac disease. The sensitivity, specificity, positive predictive value, and negative predictive value for IgA tTG were 90.9%, 90.9%, 28.6%, and 99.6%. When adopting a 2-step approach using tTG first and then EMA the sensitivity, specificity, positive predictive value, and negative predictive value was 85.7%, 98.6%, 71.7%, and 99.7%, respectively. The use of nondeamidated IgA/IgG gliadin antibodies conferred no additional diagnostic benefit when considering the detection of adult celiac disease. In the second group 48 patients with celiac disease on a gluten-free diet were identified. Sixteen of 48 of these patients had persisting villous atrophy, but 7 of 16 (44%) had a normal tTG level. CONCLUSIONS: IgA tTG alone is a sensitive marker for celiac disease. A normal tTG level does not predict recovery of villous atrophy in patients with celiac disease on a gluten-free diet. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/18328437/What_is_the_role_of_serologic_testing_in_celiac_disease_A_prospective_biopsy_confirmed_study_with_economic_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(07)01150-0 DB - PRIME DP - Unbound Medicine ER -