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Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report.
J Pediatr Gastroenterol Nutr. 2012 Feb; 54(2):229-41.JP

Abstract

OBJECTIVE

The aim of this study was to summarise the evidence from 2004 to September 2009 on the performance of laboratory-based serological and point of care (POC) tests for diagnosing coeliac disease (CD) in children using histology as reference standard.

PATIENTS AND METHODS

We searched MEDLINE and EMBASE for studies reporting on children for tests based on IgA and IgG anti-gliadin (AGA), endomysial (EmA), anti-transglutaminase-2 (TG2), and anti-deamidated gliadin peptides (DGP) antibodies or POC tests. For inclusion, histological analysis of duodenal biopsies and sensitivity and specificity for index tests had to be reported. Data were pooled and summary measures calculated for sensitivity, specificity, positive and negative likelihood ratios ("LR+", "LR-"), and diagnostic odds ratios (DOR). In case of elevated statistical heterogeneity, studies reaching 90% sensitivity or specificity were reported.

RESULTS

A total of 2510 articles were reviewed; 16 entered meta-analysis, reporting on 3110 patients (1876 with CD, 1234 without CD). For IgA-EmA, sensitivity was ≥90% in 7/11 studies and pooled specificity 98.2%. For IgA-anti-TG2, 11/15 studies yielded sensitivities ≥90% and 13/15 specificities ≥90%. For IgA-DGP, sensitivity ranged between 80.7% and 95.1% (specificity 86.3%-93.1%); for IgG-DGP between 80.1% and 98.6% (specificity 86.0-96.9%). IgA-EmA had the highest pooled DOR (554) and LR+ (31.8) for a laboratory test, followed by IgA-anti-TG2, IgG-DGP, IgA-DGP and IgA-AGA. POC tests showed a pooled sensitivity of 96.4% for IgA-TG2 (specificity 97.7%).

CONCLUSIONS

IgA-EmA and IgA-anti-TG2 tests appear highly accurate to diagnose CD. IgG-anti-DGP tests may help in excluding CD. IgA-AGA and IgA-DGP tests show inferior accuracy. POC tests may achieve high accuracy in the hands of experienced readers, but IgA-anti-TG2/EmA were superior.

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Authors+Show Affiliations

Giersiepen K
Centre for Social Policy Research, University of Bremen, Bremen, Germany. giersiepen@zes.uni-bremen.de
Lelgemann M
No affiliation info available
Stuhldreher N
No affiliation info available
Ronfani L
No affiliation info available
Husby S
No affiliation info available
Koletzko S
No affiliation info available
Korponay-Szabó IR
No affiliation info available
ESPGHAN Working Group on Coeliac Disease Diagnosis
No affiliation info available

MeSH

AutoantibodiesBiomarkersCeliac DiseaseChildGTP-Binding ProteinsGliadinHumansImmunoglobulin AImmunoglobulin GPoint-of-Care SystemsSensitivity and SpecificityTransglutaminases

Pub Type(s)

Evaluation Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

22266486

Citation

Giersiepen, Klaus, et al. "Accuracy of Diagnostic Antibody Tests for Coeliac Disease in Children: Summary of an Evidence Report." Journal of Pediatric Gastroenterology and Nutrition, vol. 54, no. 2, 2012, pp. 229-41.
Giersiepen K, Lelgemann M, Stuhldreher N, et al. Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report. J Pediatr Gastroenterol Nutr. 2012;54(2):229-41.
Giersiepen, K., Lelgemann, M., Stuhldreher, N., Ronfani, L., Husby, S., Koletzko, S., & Korponay-Szabó, I. R. (2012). Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report. Journal of Pediatric Gastroenterology and Nutrition, 54(2), 229-41. https://doi.org/10.1097/MPG.0b013e318216f2e5
Giersiepen K, et al. Accuracy of Diagnostic Antibody Tests for Coeliac Disease in Children: Summary of an Evidence Report. J Pediatr Gastroenterol Nutr. 2012;54(2):229-41. PubMed PMID: 22266486.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report. AU - Giersiepen,Klaus, AU - Lelgemann,Monika, AU - Stuhldreher,Nina, AU - Ronfani,Luca, AU - Husby,Steffen, AU - Koletzko,Sibylle, AU - Korponay-Szabó,Ilma R, AU - ,, PY - 2012/1/24/entrez PY - 2012/1/24/pubmed PY - 2012/9/5/medline SP - 229 EP - 41 JF - Journal of pediatric gastroenterology and nutrition JO - J Pediatr Gastroenterol Nutr VL - 54 IS - 2 N2 - OBJECTIVE: The aim of this study was to summarise the evidence from 2004 to September 2009 on the performance of laboratory-based serological and point of care (POC) tests for diagnosing coeliac disease (CD) in children using histology as reference standard. PATIENTS AND METHODS: We searched MEDLINE and EMBASE for studies reporting on children for tests based on IgA and IgG anti-gliadin (AGA), endomysial (EmA), anti-transglutaminase-2 (TG2), and anti-deamidated gliadin peptides (DGP) antibodies or POC tests. For inclusion, histological analysis of duodenal biopsies and sensitivity and specificity for index tests had to be reported. Data were pooled and summary measures calculated for sensitivity, specificity, positive and negative likelihood ratios ("LR+", "LR-"), and diagnostic odds ratios (DOR). In case of elevated statistical heterogeneity, studies reaching 90% sensitivity or specificity were reported. RESULTS: A total of 2510 articles were reviewed; 16 entered meta-analysis, reporting on 3110 patients (1876 with CD, 1234 without CD). For IgA-EmA, sensitivity was ≥90% in 7/11 studies and pooled specificity 98.2%. For IgA-anti-TG2, 11/15 studies yielded sensitivities ≥90% and 13/15 specificities ≥90%. For IgA-DGP, sensitivity ranged between 80.7% and 95.1% (specificity 86.3%-93.1%); for IgG-DGP between 80.1% and 98.6% (specificity 86.0-96.9%). IgA-EmA had the highest pooled DOR (554) and LR+ (31.8) for a laboratory test, followed by IgA-anti-TG2, IgG-DGP, IgA-DGP and IgA-AGA. POC tests showed a pooled sensitivity of 96.4% for IgA-TG2 (specificity 97.7%). CONCLUSIONS: IgA-EmA and IgA-anti-TG2 tests appear highly accurate to diagnose CD. IgG-anti-DGP tests may help in excluding CD. IgA-AGA and IgA-DGP tests show inferior accuracy. POC tests may achieve high accuracy in the hands of experienced readers, but IgA-anti-TG2/EmA were superior. SN - 1536-4801 UR - https://www.unboundmedicine.com/medline/citation/22266486/Accuracy_of_diagnostic_antibody_tests_for_coeliac_disease_in_children:_summary_of_an_evidence_report_ L2 - https://doi.org/10.1097/MPG.0b013e318216f2e5 DB - PRIME DP - Unbound Medicine ER -