Celiac disease serology in patients with different pretest probabilities: is biopsy avoidable?
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.
Sugai
Emilia
E
Small Bowel Section, Department of Medicine, Gastroenterology Hospital Dr. C. Bonorino Udaondo, Av. Caseros 2061, Ciudad de Buenos Aires, Argentina.
Moreno
María L
ML
Hwang
Hui J
HJ
Cabanne
Ana
A
Crivelli
Adriana
A
Nachman
Fabio
F
Vázquez
Horacio
H
Niveloni
Sonia
S
Argonz
Julio
J
Mazure
Roberto
R
La Motta
Graciela
G
Caniggia
María E
ME
Smecuol
Edgardo
E
Chopita
Néstor
N
Gómez
Juan C
JC
Mauriño
Eduardo
E
Bai
Julio C
JC
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
D001323:Autoantibodies; D005903:Gliadin; D011503:Transglutaminases