Another large study (KJ Werkstetter et al. Gastroenterol 2017; 153: 924-35) shows a high accuracy of diagnosing celiac disease (CD) without a biopsy when very high celiac titers are identified in symptomatic patients. A previous study (n=898) this year also showed similar findings: The Non-Biopsy Diagnosis of Pediatric Celiac Disease

The current study (2001-2014) identified 743 consecutive pediatric patients with positive celiac serology (TTG-IgA). Key findings:

• If TTG-IgA was higher than 10-fold the upper limit of normal and a separate sample tested positive for endomysial antibodies, then non-biopsy approach had a positive predictive value >99.6%.  The authors utilized a variety of TTG-IgA assays.
• The authors noted that HLA-DQ2/DQ8 typing did not improve the accuracy of CD diagnosis.  “Negative results for HLA-DQ2/DQ8 in patients with TGA or EMA positivity are most likely false negative …or due to very rare risk-allele combinations not recognized by the test systems.”
• “At least 50% of affected children in clinical practice will benefit from this nonbiopsy approach, which reduces burden and risks of endoscopy and anesthesia” and is more cost-effective.

The authors’ conclusion: “allowing omission of biopsies enables a correct diagnosis of CD in symptomatic children if TTG-IgA exceed 10xULN and positive EMA-IgA confirms celiac disease autoimmunity in a second blood sample. If one of these criteria is not fulfilled, biopsy should be performed to confirm the diagnosis.”

My take: This study provides convincing data that CD diagnosis does NOT require an intestinal biopsy under specific conditions.

Related blog posts:

• Followup Biopsies in Pediatric Celiac Disease?
• How Slow Do Objective Markers of Celiac Change After Treatment? | gutsandgrowth
• Are followup biopsies necessary in celiac disease? Look beyond the headlines
• To biopsy or not to biopsy -that is the question (for Celiac disease)
• How Accurate is Serology at Predicting Mucosal Healing in Celiac Disease
• Drug Therapy for Celiac Disease | gutsandgrowth
• Why is Celiac Disease Becoming More Prevalent? | gutsandgrowth
• Benefits of Gluten–Free Diet for “Asymptomatic” Celiac | gutsandgrowth
• Closer followup for Celiac disease & pediatric … – gutsandgrowth

Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.