BACKGROUND: The new ESPGHAN guidelines for diagnosis of paediatric coeliac disease suggest to avoid biopsy in genetically pre-disposed and symptomatic individuals with positive anti-endomysial antibodies (EMA) and anti-tissue transglutaminases (a-tTG). However, duodenal biopsy remains the gold standard in adult coeliac disease. AIMS: To establish the cut-off values of a-tTG, which would: predict the presence of duodenal histology (Marsh ≥2) diagnostic for coeliac disease; and predict the presence of villous atrophy (Marsh 3) in adults. METHODS: We performed an observational prospective study including all consecutive adult patients with suspected coeliac disease. All subjects were tested for EMA and a-tTG. Coeliac disease diagnosis was made in presence of Marsh ≥2, a-tTG >7 U/mL and positive EMA. A ROC curve was constructed to establish the best specificity cut-off of a-tTG levels, which would predict the presence of Marsh ≥2 and Marsh 3 at histology. RESULTS: The study included 310 patients with positive antibodies. Histology showed Marsh 1 in 8.7%, Marsh 2 in 3.5%, Marsh 3 in 87.7%. The best cut-off value of a-tTG for predicting Marsh ≥2 was 45 U/mL (sensitivity 70%; specificity 100%; PPV 100%; NPV 24.1%); the best cut-off for predicting villous atrophy was 62.4 U/mL (sensitivity 69%, specificity 100%; PPV 100%; NPV 31%). CONCLUSIONS: The diagnosis of coeliac disease can be reached without histology in adult patients with positive EMA and a-tTG levels >45 U/mL. An a-tTG level >62.4 was diagnostic for villous atrophy. These results could contribute to improving the diagnosis of coeliac disease by allowing for a significant reduction in diagnosis-related costs.
BACKGROUND: The new ESPGHAN guidelines for diagnosis of paediatric coeliac disease suggest to avoid biopsy in genetically pre-disposed and symptomatic individuals with positive anti-endomysial antibodies (EMA) and anti-tissue transglutaminases (a-tTG). However, duodenal biopsy remains the gold standard in adult coeliac disease. AIMS: To establish the cut-off values of a-tTG, which would: predict the presence of duodenal histology (Marsh ≥2) diagnostic for coeliac disease; and predict the presence of villous atrophy (Marsh 3) in adults. METHODS: We performed an observational prospective study including all consecutive adult patients with suspected coeliac disease. All subjects were tested for EMA and a-tTG. Coeliac disease diagnosis was made in presence of Marsh ≥2, a-tTG >7 U/mL and positive EMA. A ROC curve was constructed to establish the best specificity cut-off of a-tTG levels, which would predict the presence of Marsh ≥2 and Marsh 3 at histology. RESULTS: The study included 310 patients with positive antibodies. Histology showed Marsh 1 in 8.7%, Marsh 2 in 3.5%, Marsh 3 in 87.7%. The best cut-off value of a-tTG for predicting Marsh ≥2 was 45 U/mL (sensitivity 70%; specificity 100%; PPV 100%; NPV 24.1%); the best cut-off for predicting villous atrophy was 62.4 U/mL (sensitivity 69%, specificity 100%; PPV 100%; NPV 31%). CONCLUSIONS: The diagnosis of coeliac disease can be reached without histology in adult patients with positive EMA and a-tTG levels >45 U/mL. An a-tTG level >62.4 was diagnostic for villous atrophy. These results could contribute to improving the diagnosis of coeliac disease by allowing for a significant reduction in diagnosis-related costs.
Authors: Emilia Sugai; Hui J Hwang; Horacio Vázquez; María L Moreno; Florencia Costa; Gabriela Longarini; María I Pinto-Sánchez; Sonia Niveloni; Edgardo Smecuol; Roberto M Mazure; Elena F Verdu; Eduardo Mauriño; Julio C Bai Journal: Am J Gastroenterol Date: 2015-10 Impact factor: 10.864
Authors: Marcis Leja; Zakera Shums; Liene Nikitina-Zake; Mikus Gavars; Ilze Kikuste; Jay Milo; Ilva Daugule; Jelena Pahomova; Valdis Pirags; Vilnis Dzerve; Janis Klovins; Andrejs Erglis; Gary L Norman Journal: United European Gastroenterol J Date: 2015-04 Impact factor: 4.623
Authors: Marco Di Tola; Mariacatia Marino; Simone Goetze; Rossella Casale; Sara Di Nardi; Raffaele Borghini; Giuseppe Donato; Antonio Tiberti; Antonio Picarelli Journal: J Gastroenterol Date: 2016-02-29 Impact factor: 7.527
Authors: Norelle R Reilly; Steffen Husby; David S Sanders; Peter H R Green Journal: Nat Rev Gastroenterol Hepatol Date: 2017-10-11 Impact factor: 46.802