Do you still need a biopsy to diagnose celiac disease?
Celiac disease is a common and permanent condition caused by an abnormal immune response to ingested gluten in genetically susceptible individuals. Its proper diagnosis is very important even in patients presenting with mild symptoms because severe and debilitating complications may occur in celiac patients not following a strict gluten-free diet. In the past several years, important progress has been made not only in our understanding of the pathogenesis of this condition but also in the availability of tools to screen it. Antigliadin antibodies, once largely used for this purpose, have been basically replaced by the more costly but far more accurate antiendomysium antibodies. More recently, the enzyme-linked immunosorbent assay (ELISA), which measures the antibodies directed against the autoantigen responsible for the disease (tissue transglutaminase), has also been developed and tested as a screening tool. Currently, however, the poor positive predictive value of this test does not allow practitioners to diagnose celiac disease without the duodenal biopsy showing the typical morphologic changes.
Guandalini
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S
Department of Pediatrics, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA. sguandal@peds.bsd.uchicago.edu
Gupta
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P
D000465:Algorithms; D001323:Autoantibodies / Q000276:immunology*; D001706:Biopsy; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology*; D003938:Diagnostic Techniques, Digestive System; D004386:Duodenum / Q000473:pathology*; D004797:Enzyme-Linked Immunosorbent Assay; D019204:GTP-Binding Proteins / Q000276:immunology; D020022:Genetic Predisposition to Disease; D005903:Gliadin / Q000276:immunology; D006801:Humans; D011237:Predictive Value of Tests; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012698:Serologic Tests / Q000379:methods; D011503:Transglutaminases / Q000276:immunology
D001323:Autoantibodies; D005903:Gliadin; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins