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Serology-based criteria for adult coeliac disease have excellent accuracy across the range of pre-test probabilities.

Abstract：

BACKGROUND:The revised paediatric criteria for coeliac disease allow omission of duodenal biopsies in symptomatic children who have specific serology and coeliac disease-associated genetics. It remains unclear whether this approach is also applicable for adults with various clinical presentations. AIM:To evaluate the accuracy of serology-based criteria in adults with variable pre-test probabilities for coeliac disease. METHODS:Three study cohorts comprised adults with high-risk clinical coeliac disease suspicion (n = 421), moderate-risk family members of coeliac disease patients (n = 2357), and low-risk subjects from the general population (n = 2722). Serological and clinical data were collected, and "triple criteria" for coeliac disease comprised transglutaminase 2 antibodies >10× the upper limit of normal, positive endomysium antibodies, and appropriate genetics without requirement of symptoms. The diagnosis was based on intestinal biopsy. RESULTS:The diagnosis of coeliac disease was established in 274 subjects. Of these, 59 high-risk subjects, 17 moderate-risk subjects, and 14 low-risk subjects fulfilled the "triple criteria". All had histologically proven coeliac disease, giving the criteria a positive predictive value of 100%. Altogether, 90 (33%) of all 274 newly diagnosed patients could have avoided biopsy, including 37% among high-risk, 20% among moderate-risk, and 48% among low-risk patients. No histological findings other than coeliac disease were found in the biopsies of "triple positive" subjects. CONCLUSIONS:Coeliac disease can reliably and safely be diagnosed without biopsy in adults fulfilling the "triple criteria" regardless of the pre-test probability. Revised criteria would enable the number of endoscopies to be reduced by one-third.

journal_name

Aliment Pharmacol Ther

journal_title

Alimentary pharmacology & therapeutics

authors

Fuchs V,Kurppa K,Huhtala H,Laurila K,Mäki M,Collin P,Salmi T,Luostarinen L,Saavalainen P,Kaukinen K

doi

10.1111/apt.15109

subject

Has Abstract

pub_date

2019-02-01 00:00:00

pages

277-284

issue

eissn

0269-2813

issn

1365-2036

journal_volume

pub_type

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Serology-based criteria for adult coeliac disease have excellent accuracy across the range of pre-test probabilities.