[Celiac News] Coeliac disease: a biopsy is not always necessary for diagnosis

[News Bot]

Coeliac disease: a biopsy is not always necessary for diagnosis
           

Alimentary Pharmacology & Therapeutics, Volume 27, Issue 7, Page 572-577, April 2008.
      
   SummaryBackground In view of the high diagnostic accuracy of immunoglobulin-A-tissue transglutaminase antibodies for detecting coeliac disease, we have explored whether a small bowel biopsy is always required to establish the diagnosis.Aim To define the ... (Source: Alimentary Pharmacology and Therapeutics)
           

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2036.2008.03609.x?ai=s6&mi=4mpuw&af=R
           

[CarolM]

It will be interesting to see how this works out.

Coeliac disease: a biopsy is not always necessary for diagnosis

P. G. HILL & G. K. T. HOLMESDepartments of Chemical Pathology and Gastroenterology, Derbyshire Royal Infirmary, Derby, UK

Dr G. K. T. Holmes, Department of Gastroenterology, Derbyshire Royal Infirmary, London Road, Derby DE1 2QY, UK.
E-mail: geoffreyholmes@compuserve.com

Summary
 
Background: In view of the high diagnostic accuracy of immunoglobulin-A-tissue transglutaminase antibodies for detecting coeliac disease, we have explored whether a small bowel biopsy is always required to establish the diagnosis.

Aim: To define the transglutaminase antibody level giving a positive predictive value for coeliac disease of 100% and to subsequently assess the proportion of new diagnoses of coeliac disease having such a result.

Methods: The Celikey kit (Phadia GmbH, Frieburg, Germany) was used to measure transglutaminase antibody levels.

Results: All patients with transglutaminase antibody levels >30 U/mL, i.e. 10 × upper limit of normal in 2002/2003 had characteristic small bowel mucosal lesions. In a subsequent audit, 58% of 112 new diagnoses of coeliac disease in 2004/2005 had levels above this cut-off value.

Conclusions: We have shown that a transglutaminase antibody level can be defined which gives a positive predictive value of 100% for coeliac disease. From published data, these observations can be extended to most second-generation transglutaminase antibody kits. Our data provide further evidence that diagnostic guidelines could be modified so that small bowel biopsy is no longer regarded as mandatory in patients with such high transglutaminase antibody levels. This will avoid an invasive procedure and lead to a more rapid diagnosis and earlier treatment for over half of the new patients with coeliac disease.
 

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2036.2008.03609.x

[the sensible celiac]

Sounds like a good development to me.  People with sky high blood antigen levels who also have a family history of celiac disease should certainly be considered as having celiac disease IMHO - but I'm not a doctor.

If this ends up making more doctors less dogmatic about requiring a biopsy I think that would be a good result.