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Can Celiac Disease be Diagnosed without Intestinal Biopsy?

Celiac.com 05/28/2013 - Is an intestinal biopsy always necessary to diagnose celiac disease, or can diagnosis be made without biopsy? To answer that question, a team of researchers recently set out to compare celiac disease–specific antibody tests to determine if they could replace jejunal biopsy in patients with a high pretest probability of celiac disease.

Image: Public Domain--WikicommonsThe research team included Annemarie Bürgin-Wolff, Buser Mauro, and Hadziselimovic Faruk. They are variously affiliated with the Institute for Celiac Disease in Liestal, Switzerland, and Statistik Dr. M. Buser, Riehen, Switzerland.

Their retrospective study included blood test data from 149 patients with celiac disease, along with 119 controls. All patients underwent intestinal biopsy, and all samples were analyzed for IgA and IgG antibodies against native gliadin (ngli) and deamidated gliadin peptides (dpgli), as well as for IgA antibodies against tissue transglutaminase and endomysium.

They found that tests for dpgli were superior to ngli for IgG antibody determination: 68% vs. 92% specificity and 79% vs. 85% sensitivity for ngli and dpgli, respectively. Predictive values were also higher for dpgli than for ngli; positive (76% vs. 93%) and negative (72% vs. 83%).

Regarding IgA gliadin antibody determination, sensitivity improved from 61% to 78% with dpgli, while specificity and positive predictive value remained at 97% (P less than 0.00001).

A combination of four tests (IgA anti-dpgli, IgG anti-dpgli, IgA anti- tissue transglutaminase, and IgA anti-endomysium) yielded positive and negative predictive values of 99% and 100%, respectively and a likelihood ratio positive of 86 with a likelihood ratio negative of 0.00.

Omitting the endomysium antibody determination still yielded positive and negative predictive values of 99% and 98%, respectively and a likelihood ratio positive of 87 with a likelihood ratio negative of 0.01.

Conclusion: Antibody tests for dpgli yielded superior results compared with ngli. A combination of three or four antibody tests including IgA anti-tissue transglutaminase and/or IgA anti- endomysium enabled reliable diagnosis or exclusion of celiac disease without intestinal biopsy in 78 percent of patients.

This two-step method of performing jejunal biopsy only in patients with discordant antibody results (22%) would catch all patients except those with no celiac-specific antibodies; who would then be caught through biopsy.

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17 Responses:

 
Matt Lewis
Rating: ratingfullratingemptyratingemptyratingemptyratingempty Unrated
said this on
28 May 2013 8:32:36 AM PST
My wife was diagnosed with celiac disease after stomach biopsy and blood tests were all negative.

She was diagnosed with celiac disease from a capsule endoscopy. Stomach and duodenal biopsies are the tip of the 9 feet of jejunum and often miss celiac disease...

 
Jenny
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said this on
03 Jun 2013 2:09:09 PM PST
Yes I know at least 50 celiacs diagnosed by capsule when standard biopsy and/or blood test was negative.

 
Dylan Cornelius
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said this on
23 Oct 2014 3:57:34 PM PST
Hi Matt,
Where do you find the data that stomach and duodenal biopsies often miss celiac disease? Appreciate your help!

 
tony
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said this on
30 May 2013 3:43:22 PM PST
I had one GI doctor, swear I had it through blood tests and the fact that I have dermatitis herpetiformis since I was 12 years old. The other GI doctor did a biopsy during a colonoscopy. He swears I don't have it. Pasta is the item that gets me sick. But only for the last 5 years, when I was young I ate ziti, ravs and all pasta with no problems.

 
Andrea

said this on
03 Jun 2013 11:28:28 AM PST
Tony,

Doctors at the New York Presbyterian Celiac Center who are world renowned for their research, studies and treatment of celiac disease say that dermatitis herpetiformis is a condition that confirms the presence of celiac disease in patients who are not otherwise confirmed. If you have the anti-bodies as well, then you have a diagnosis of celiac disease.

 
Rob Carroll
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said this on
03 Jun 2013 9:47:16 AM PST
I never had a positive blood test, but the endoscopy (which my 3rd GI ordered for an unrelated reason) found it right away. I don't know if these were the same series of blood tests they were using 10 years ago, but I know a lot of people who had false negatives.

 
Rosalyn
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said this on
03 Jun 2013 8:59:07 PM PST
I could not understand one word in this article; therefore I learned nothing that would be helpful. The article was too technical and not written for the average gluten-free person trying to learn more about the disease.

 
Mo
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said this on
02 Jul 2013 5:37:19 PM PST
I so agree with you! I was hoping that I'm not getting a little senile.

 
LKay
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said this on
15 Feb 2014 7:13:18 PM PST
I agree. I think it would be helpful if the article was in English and not medical-alphabet soup.

 
Jules
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said this on
04 Jun 2013 5:47:46 PM PST
Do patients undergoing the tests have to be eating gluten to test positive?

 
Adamaris
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said this on
27 Sep 2013 9:11:38 AM PST
I also would like to know if I have to eat before taking the blood test, IGA-TTG, I'm so confused because when I eat food containing gluten I get sick.

 
laura craigo
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said this on
05 Jun 2013 9:49:02 AM PST
I have had four positive blood tests months and months apart, but I tested negative on biopsy.

 
Duane Benton
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said this on
05 Jun 2013 10:50:06 AM PST
I had one positive and one negative blood test, but definitely have celiac disease from gluten-free diet results.

 
Jen
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said this on
01 Oct 2013 10:08:20 PM PST
I was diagnosed two weeks ago through a blood test. My doctor explained that I needed a biopsy to have an "official" diagnosis, but he usually didn't order such an invasive procedure unless it was a severe case or unless the patient requested it (I certainly didn't want to deal with that, so I just took his word for it). In two weeks of a GF diet, I'm sleeping better, I don't have abdominal discomfort, my nausea and vomiting is gone, I've lost a significant amount of weight, my thyroid problems have stabilized (for the moment; more bloodwork in a month to confirm) and I just FEEL better. The other day, my mother-in-law made a dessert which she assured me was gluten free. It wasn't (who doesn't know that flour is made from wheat???), and I had horrendous stomach pain for two hours after eating it. I don't need a biopsy to confirm what I already know. I know everyone is different, but in my case, the blood test was more than enough.

 
Julia
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said this on
07 Jan 2014 5:02:54 PM PST
I have heard that there are tax deductions for people DIAGNOSED with celiac. I am sure a biopsy is not worth the while to get them, however, i would make it very clear to your doctor, how you feel after a GF diet and express that it should be noted in your chart. I believe the actual problem lies between diagnosing celiac or gluten intolerance, which is probably the reason for a biopsy.

 
Mlal
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said this on
04 Feb 2014 3:54:13 PM PST
Can you expand on what these tax deductions are? How does that work, can you deduct gluten free food as medical expenses or pay them from a health account?

 
Val
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said this on
10 Mar 2014 8:25:12 PM PST
I recently had a negative blood test for celiac and when I had an EGD they took only one biopsy in the small intestine, which came back negative. I am now attempting a gluten free diet and feeling better to a degree. The problems I was having included 20 pound weight loss in 2 months, being extremely shaky, exhausted, dizzy, moody after eating and unable to think clearly. My mom wants me to request a CT scan and not wait on the gluten few diet. I was wondering if anyone had any input on my symptoms from their own experiences?




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