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

Penny, H. A. et al. (2020) Accuracy of a no-biopsy approach for the diagnosis of coeliac disease across different adult cohorts. Gut, 70(5), pp. 876-883. (doi: 10.1136/gutjnl-2020-320913) (PMID:33139268) (PMCID:PMC8040155)

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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Derakhshan, Professor Mohammad
• Authors: Penny, H. A., Raju, S. A., Lau, M. S., Marks, L. J., Baggus, E. M., Bai, J. C., Bassotti, G., Bontkes, H. J., Carroccio, A., Danciu, M., Derakhshan, M., Ensari, A., Ganji, A., Green, P. H. R., Johnson, M. W., Ishaq, S., Lebwohl, B., Levene, A., Maxim, R., Mohaghegh Shalmani, H., Rostami-Nejad, M., Rowlands, D., Spiridon, I. A., Srivastava, A., Volta, U., Villanacci, V., Wild, G., Cross, S. S., Rostami, K., and Sanders, D. S.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Journal Name: Gut
• Publisher: BMJ Publishing Group
• ISSN: 0017-5749
• ISSN (Online): 1468-3288
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Gut 70(5):876-883
• Publisher Policy: Reproduced under a Creative Commons licence