TY - JOUR
T1 - Accuracy of a no-biopsy approach for the diagnosis of coeliac disease across different adult cohorts
AU - Carroccio, Antonio
AU - Danciu, Mihai
AU - Derakhshan, Mohammad H
AU - Ishaq, Sauid
AU - Ganji, Azita
AU - Bai, Julio C
AU - Villanacci, Vincenzo
AU - Maxim, Roxana
AU - Rostami, Kamran
AU - Johnson, Matt W
AU - Srivastava, Amitabh
AU - Penny, Hugo A
AU - Raju, Suneil A
AU - Lau, Michelle S
AU - Rostami-Nejad, Mohammad
AU - Marks, Lauren Js
AU - Mohaghegh Shalmani, Hamid
AU - Baggus, Elisabeth Mr
AU - Cross, Simon S
AU - Spiridon, Irene A
AU - Rowlands, David
AU - Lebwohl, Benjamin
AU - Bontkes, Hetty J
AU - Ensari, Arzu
AU - Volta, Umberto
AU - Bassotti, Gabrio
AU - Wild, Graeme
AU - Sanders, David S
AU - Levene, Adam
AU - Green, Peter H R
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
UR - http://hdl.handle.net/10447/522547
M3 - Article
VL - 70
SP - 876
EP - 883
JO - Gut
JF - Gut
SN - 0017-5749
ER -