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Defining thresholds of antibody levels improves diagnosis of celiac disease.
Clin Gastroenterol Hepatol 2013; 11(4):398-403; quiz e32CG

Abstract

BACKGROUND & AIMS

The European Society for Pediatric Gastroenterology and Nutrition proposed guidelines for the diagnosis of celiac disease, stating that duodenal biopsy is no longer needed if patients have symptoms and levels of immunoglobulin A anti-tissue transglutaminase (IgA anti-tTG) more than 10-fold the cut-off value. We evaluated the accuracy of this guideline in a well-characterized population using different commercial assays.

METHODS

We analyzed levels of IgA anti-tTG in serum samples from 104 consecutive pediatric and adult patients who were not deficient in IgA and were diagnosed with celiac disease from August 1, 2000, to December 31, 2009. We also analyzed serum samples from 537 consecutive patients without celiac disease (controls), collected from May 1, 2004, to October 12, 2006, who underwent intestinal biopsy analysis. Serum levels of antibodies were quantified using assays from Bio-Rad, INOVA, Genesis, and Thermo Fisher.

RESULTS

The likelihood ratio (probability of a specific result in patients divided by the probability of the same result in controls) for celiac disease increased with levels of IgA anti-tTG in all assays. Depending on the assay, the likelihood ratio for levels greater than 10-fold the cut-off value ranged from 111 to 294. The percentage of patients with celiac disease with levels of IgA anti-tTG greater than 10-fold the cut-off value ranged from 41% to 61%, depending on the assay. For levels of anti-tTG greater than 10-fold the cut-off value, the post-test probabilities for celiac disease (probability of disease, based on pretest probability and test result) were, depending on the assay, 89%-96% and 53%-75% for pretest probabilities (probability of disease depending on symptoms) of 7% and 1%, respectively.

CONCLUSIONS

To diagnose celiac disease based on serologic factors, it might be best to define thresholds for levels of IgA anti-tTG based on a predefined likelihood ratio or post-test probability, instead of a multiple of a cut-off value. Patients with a high pretest probability and levels of anti-tTG greater than 10-fold the cut-off value have a high probability for having celiac disease, aiding clinical decision making.

Authors+Show Affiliations

Laboratory Medicine, Immunology, University Hospitals Leuven, Catholic University of Leuven, Leuven, Belgium.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23103822

Citation

Vermeersch, Pieter, et al. "Defining Thresholds of Antibody Levels Improves Diagnosis of Celiac Disease." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 11, no. 4, 2013, pp. 398-403; quiz e32.
Vermeersch P, Geboes K, Mariën G, et al. Defining thresholds of antibody levels improves diagnosis of celiac disease. Clin Gastroenterol Hepatol. 2013;11(4):398-403; quiz e32.
Vermeersch, P., Geboes, K., Mariën, G., Hoffman, I., Hiele, M., & Bossuyt, X. (2013). Defining thresholds of antibody levels improves diagnosis of celiac disease. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 11(4), pp. 398-403; quiz e32. doi:10.1016/j.cgh.2012.10.025.
Vermeersch P, et al. Defining Thresholds of Antibody Levels Improves Diagnosis of Celiac Disease. Clin Gastroenterol Hepatol. 2013;11(4):398-403; quiz e32. PubMed PMID: 23103822.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Defining thresholds of antibody levels improves diagnosis of celiac disease. AU - Vermeersch,Pieter, AU - Geboes,Karel, AU - Mariën,Godelieve, AU - Hoffman,Ilse, AU - Hiele,Martin, AU - Bossuyt,Xavier, Y1 - 2012/10/25/ PY - 2012/07/14/received PY - 2012/10/02/revised PY - 2012/10/12/accepted PY - 2012/10/30/entrez PY - 2012/10/30/pubmed PY - 2013/9/11/medline SP - 398-403; quiz e32 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 11 IS - 4 N2 - BACKGROUND & AIMS: The European Society for Pediatric Gastroenterology and Nutrition proposed guidelines for the diagnosis of celiac disease, stating that duodenal biopsy is no longer needed if patients have symptoms and levels of immunoglobulin A anti-tissue transglutaminase (IgA anti-tTG) more than 10-fold the cut-off value. We evaluated the accuracy of this guideline in a well-characterized population using different commercial assays. METHODS: We analyzed levels of IgA anti-tTG in serum samples from 104 consecutive pediatric and adult patients who were not deficient in IgA and were diagnosed with celiac disease from August 1, 2000, to December 31, 2009. We also analyzed serum samples from 537 consecutive patients without celiac disease (controls), collected from May 1, 2004, to October 12, 2006, who underwent intestinal biopsy analysis. Serum levels of antibodies were quantified using assays from Bio-Rad, INOVA, Genesis, and Thermo Fisher. RESULTS: The likelihood ratio (probability of a specific result in patients divided by the probability of the same result in controls) for celiac disease increased with levels of IgA anti-tTG in all assays. Depending on the assay, the likelihood ratio for levels greater than 10-fold the cut-off value ranged from 111 to 294. The percentage of patients with celiac disease with levels of IgA anti-tTG greater than 10-fold the cut-off value ranged from 41% to 61%, depending on the assay. For levels of anti-tTG greater than 10-fold the cut-off value, the post-test probabilities for celiac disease (probability of disease, based on pretest probability and test result) were, depending on the assay, 89%-96% and 53%-75% for pretest probabilities (probability of disease depending on symptoms) of 7% and 1%, respectively. CONCLUSIONS: To diagnose celiac disease based on serologic factors, it might be best to define thresholds for levels of IgA anti-tTG based on a predefined likelihood ratio or post-test probability, instead of a multiple of a cut-off value. Patients with a high pretest probability and levels of anti-tTG greater than 10-fold the cut-off value have a high probability for having celiac disease, aiding clinical decision making. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/23103822/Defining_thresholds_of_antibody_levels_improves_diagnosis_of_celiac_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(12)01280-3 DB - PRIME DP - Unbound Medicine ER -