The serological diagnosis of coeliac disease - a step forward

geoffrey Holmes, Carolina Ciacci

Abstract


91

The development of highly performing serological tests to identify patients with coeliac disease (CD), allowed large scale screening studies to be carried out and the results transformed our understanding of the prevalence of the condition in the general population. The next logical step was to ask whether CD could be reliably diagnosed by these tests without the need for small intestinal biopsies. This was shown to be the case. Studies from Derby, UK, indicated that about half of adult patients can be diagnosed in this way and similar figures have been provided for children. When considering this approach, it is essential that laboratories only use highly performing test kits that they have validated to measure tissue transglutaminase antibodies because all kits do not function to the same high standard. There remains a place for biopsy when criteria for serological diagnosis are not met, if the diagnosis of CD is strongly suspected but serological tests are negative or in patients not showing the expected responses to gluten free diet or otherwise causing concern, when not only small bowel biopsy will be indicated but also other investigations. Those with refractory CD should not be compromised by this diagnostic strategy. As serological tests become more refined and information accumulates, it is likely that this mode of diagnosis will gather momentum for the benefit of patients and carers. This brief review looks at the evidence for making the diagnosis of CD in some cases by serological tests alone.

Keywords: Celiac disease, Tissue transglutaminase, Serology, Diagnosis.

(Please cite as: Holmes G, Ciacci C. The serological diagnosis of coeliac disease - a step forward. Gastroenterol Hepatol Bed Bench 2018;11(3):209-215).


Keywords


Coeliac; Serology; Biopsy; Avoidance; Gastroscopy

Full Text:

PDF - View Count=67

References


Kurien M, Mooney PD, Sanders DS. Editorial: is a histological diagnosis mandatory for adult patients with suspected coeliac disease? Aliment Pharmacol Ther 2015;41(1):146-7. Available at:

http://onlinelibrary.wiley.com/store/10.1111/apt.13002/asset/apt13002.pdf?v=1&t=jc7zyqp5&s=90db53895b1dfc2166aae884dda6a59db94b5e85

Austin AS, Forsyth JM, Hill PG, Holmes GK. Authors' response: British Society of Gastroenterology guidelines on the diagnosis and management of coeliac disease. Gut 2016;65(4):717. Available at:

http://gut.bmj.com/content/65/4/717.1

Ludvigsson JF, Bai JC, Biagi F, Card TR, Ciacci C, Ciclitira PJ, et al. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut 2014;63(8):1210-28. Available at:

http://gut.bmj.com/content/63/8/1210

Hill PG, Holmes GK. Coeliac disease: a biopsy is not always necessary for diagnosis. Aliment Pharmacol Ther 2008;27(7):572-7. Available at:

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2008.03609.x/references

Sugai E, Moreno ML, Hwang HJ, Cabanne A, Crivelli A, Nachman F, et al. Celiac disease serology in patients with different pretest probabilities: is biopsy avoidable? World J Gastroenterol 2010;16(25):3144-52. Available at:

https://www.wjgnet.com/1007-9327/abstract/v16/i25/3144.htm

Mubarak A, Wolters VM, Gerritsen SA, Gmelig-Meyling FH, Ten Kate FJ, Houwen RH. A biopsy is not always necessary to diagnose celiac disease. J Pediatr Gastroenterol Nutr 2011;52(5):554-7. Available at:

http://journals.lww.com/jpgn/fulltext/2011/05000/A_Biopsy_Is_Not_Always_Necessary_to_Diagnose.10.aspx

Zanini B, Magni A, Caselani F, Lanzarotto F, Carabellese N, Villanacci V, et al. High tissue-transglutaminase antibody level predicts small intestinal villous atrophy in adult patients at high risk of celiac disease. Dig Liver Dis 2012;44(4):280-5. Available at:

https://www.sciencedirect.com/science/article/pii/S1590865811004117

Bürgin-Wolff A, Mauro B, Faruk H. Intestinal biopsy is not always required to diagnose celiac disease: a retrospective analysis of combined antibody tests. BMC Gastroenterol 2013;13:19. Available at:

https://link.springer.com/article/10.1186/1471-230X-13-19

Wakim-Fleming J, Pagadala MR, Lemyre MS, Lopez R, Kumaravel A, Carey WD, et al. Diagnosis of celiac disease in adults based on serology test results, without small-bowel biopsy. Clin Gastroenterol Hepatol 2013;11(5):511-6. Available at:

http://www.cghjournal.org/article/S1542-3565(13)00007-4/fulltext

Hopper AD, Hadjivassiliou M, Hurlstone DP, Lobo AJ, McAlindon ME, Egner W, et al. What is the role of serologic testing in celiac disease? A prospective, biopsy-confirmed study with economic analysis. Clin Gastroenterol Hepatol 2008;6(3):314-20. Available at:

http://www.cghjournal.org/article/S1542-3565(07)01150-0/fulltext

Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of Coeliac Disease. J Pediatr Gastroenterol Nutr 2012;54(1):136-60. Available at:

https://insights.ovid.com/pubmed?pmid=22197856

Werkstetter KJ, Korponay-Szabó IR, Popp A, Villanacci V, Salemme M, Heilig G, et al. Accuracy in Diagnosis of Celiac Disease Without Biopsies in Clinical Practice. Gastroenterology 2017;153(4):924-35. Available at:

http://www.gastrojournal.org/article/S0016-5085(17)35736-0/fulltext

Egner W, Shrimpton A, Sargur R, Patel D, Swallow K. ESPGHAN Guidance on Coeliac Disease 2012: Multiples of the Upper Limit of Normal for Decision Making Do Not Harmonise Assay Performance Across Centres. J Pediatr Gastroenterol Nutr 2012;55(6):733-35. Available at:

https://insights.ovid.com/pubmed?pmid=22744189

Beltran L, Koenig M, Egner W, Howard M, Butt A, Austin MR, et al. High-titre circulating tissue transglutaminase-2 antibodies predict small bowel villous atrophy, but decision cut-off limits must be locally validated. Clin Exp Immunol 2014;176(2):190-8. Available at:

http://onlinelibrary.wiley.com/doi/10.1111/cei.12249/abstract

Evans KE, Malloy AR, Gorard DA. Changing patterns of coeliac serology requests. Aliment Pharmacol Ther 2009;29(10):1137-42. Available at:

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2009.03982.x/abstract

Biagi F, Bianchi PI, Campanella J, Zanellati G, Corazza GR. The impact of misdiagnosing coeliac disease at a referral centre. Can J Gastroenterol 2009;23(8):543-45. Available at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732174

Aziz I, Lewis NR, Hadjivassiliou M, Winfield SN, Rugg N, Kelsall A, et al. A UK study assessing the population prevalence of self-reported gluten sensitivity and referral characteristics to secondary care. Eur J Gastroenterol Hepatol 2014;26(1):33-9. Available at:

https://insights.ovid.com/pubmed?pmid=24216570




DOI: https://doi.org/10.22037/ghfbb.v0i0.1311

Creative Commons License
GHFBB by Gastroenterology and Liver Diseases Research Institute is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

 

PISSN: 2008-2258

EISSN: 2008-4234


•  

Privacy Policy | For Author | Online Submission | About | Contact

Copyright © 2018 Shahid Beheshti University of Medical Sciences. All rights reserved.