Accuracy of a no-biopsy approach for the diagnosis of coeliac disease across different adult cohorts

Antonio Carroccio, Mihai Danciu, Mohammad H Derakhshan, Sauid Ishaq, Azita Ganji, Julio C Bai, Vincenzo Villanacci, Roxana Maxim, Kamran Rostami, Matt W Johnson, Amitabh Srivastava, Hugo A Penny, Suneil A Raju, Michelle S Lau, Mohammad Rostami-Nejad, Lauren Js Marks, Hamid Mohaghegh Shalmani, Elisabeth Mr Baggus, Simon S Cross, Irene A SpiridonDavid Rowlands, Benjamin Lebwohl, Hetty J Bontkes, Arzu Ensari, Umberto Volta, Gabrio Bassotti, Graeme Wild, David S Sanders, Adam Levene, Peter H R Green

Risultato della ricerca: Articlepeer review

Abstract

Objective We aimed to determine the predictive capacity and diagnostic yield of a 10-fold increase in serum IgA antitissue transglutaminase (tTG) antibody levels for detecting small intestinal injury diagnostic of coeliac disease (CD) in adult patients. Design The study comprised three adult cohorts. Cohort 1: 740 patients assessed in the specialist CD clinic at a UK centre; cohort 2: 532 patients with low suspicion for CD referred for upper GI endoscopy at a UK centre; cohort 3: 145 patients with raised tTG titres from multiple international sites. Marsh 3 histology was used as a reference standard against which we determined the performance characteristics of an IgA tTG titre of ≥10×ULN for a diagnosis of CD. Results Cohort 1: the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for IgA tTG levels of ≥10×ULN at identifying individuals with Marsh 3 lesions were 54.0%, 90.0%, 98.7% and 12.5%, respectively. Cohort 2: the sensitivity, specificity, PPV and NPV for IgA tTG levels of ≥10×ULN at identifying individuals with Marsh 3 lesions were 50.0%, 100.0%, 100.0% and 98.3%, respectively. Cohort 3: the sensitivity, specificity, PPV and NPV for IgA tTG levels of ≥10×ULN at identifying individuals with Marsh 3 lesions were 30.0%, 83.0%, 95.2% and 9.5%, respectively. Conclusion Our results show that IgA tTG titres of ≥10×ULN have a strong predictive value at identifying adults with intestinal changes diagnostic of CD. This study supports the use of a no-biopsy approach for the diagnosis of adult CD.
Lingua originaleEnglish
pagine (da-a)876-883
Numero di pagine8
RivistaGut
Volume70
Stato di pubblicazionePublished - 2021

All Science Journal Classification (ASJC) codes

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