title: Celiac disease serology in patients with different pretest probabilities: is biopsy avoidable?
abstract: OBJECTIVE
  To establish the diagnostic performance of several serological tests, individually and in combination, for diagnosing celiac disease (CD) in patients with different pretest probabilities, and to explore potential serological algorithms to reduce the necessity for biopsy.
  
  
  METHODS
  We prospectively performed duodenal biopsy and serology in 679 adults who had either high risk (n = 161) or low risk (n = 518) for CD. Blood samples were tested using six assays (enzyme-linked immunosorbent assay) that detected antibodies to tissue transglutaminase (tTG) and deamidated gliadin peptide (DGP).
  
  
  RESULTS
  CD prevalence was 39.1% in the high-risk population and 3.3% in the low-risk group. In high-risk patients, all individual assays had a high diagnostic efficacy [area under receiving operator characteristic curves (AU ROC): 0.968 to 0.999]. In contrast, assays had a lower diagnostic efficacy (AU ROC: 0.835 to 0.972) in the low-risk group. Using assay combinations, it would be possible to reach or rule out diagnosis of CD without biopsy in 92% of cases in both pretest populations. We observed that the new DGP/tTG Screen assay resulted in a surplus compared to more conventional assays in any clinical situation.
  
  
  CONCLUSIONS
  The DGP/tTG Screen assay could be considered as the best initial test for CD. Combinations of two tests, including a DGP/tTG Screen, might be able to diagnose CD accurately in different clinical scenarios making biopsy avoidable in a high proportion of subjects.
authors.affiliation: Small Bowel Section, Department of Medicine, Gastroenterology Hospital Dr. C. Bonorino Udaondo, Av. Caseros 2061, Ciudad de Buenos Aires, Argentina.
authors.forename: Emilia
authors.initials: E
authors.lastname: Sugai
authors.forename: María L
authors.initials: ML
authors.lastname: Moreno
authors.forename: Hui J
authors.initials: HJ
authors.lastname: Hwang
authors.forename: Ana
authors.initials: A
authors.lastname: Cabanne
authors.forename: Adriana
authors.initials: A
authors.lastname: Crivelli
authors.forename: Fabio
authors.initials: F
authors.lastname: Nachman
authors.forename: Horacio
authors.initials: H
authors.lastname: Vázquez
authors.forename: Sonia
authors.initials: S
authors.lastname: Niveloni
authors.forename: Julio
authors.initials: J
authors.lastname: Argonz
authors.forename: Roberto
authors.initials: R
authors.lastname: Mazure
authors.forename: Graciela
authors.initials: G
authors.lastname: La Motta
authors.forename: María E
authors.initials: ME
authors.lastname: Caniggia
authors.forename: Edgardo
authors.initials: E
authors.lastname: Smecuol
authors.forename: Néstor
authors.initials: N
authors.lastname: Chopita
authors.forename: Juan C
authors.initials: JC
authors.lastname: Gómez
authors.forename: Eduardo
authors.initials: E
authors.lastname: Mauriño
authors.forename: Julio C
authors.initials: JC
authors.lastname: Bai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood / Q000276:immunology; D001706:Biopsy; D002446:Celiac Disease / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D003430:Cross-Sectional Studies; D004386:Duodenum / Q000473:pathology / Q000601:surgery; D005260:Female; D005903:Gliadin / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012698:Serologic Tests / Q000379:methods; D011503:Transglutaminases / Q000276:immunology; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D005903:Gliadin; D011503:Transglutaminases