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  • Jefferson Adams
    Jefferson Adams

    Can Celiac Disease be Diagnosed without Intestinal Biopsy?

    Reviewed and edited by a celiac disease expert.

    Caption: Image: Public Domain--Wikicommons

    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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    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...

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    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.

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    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.

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    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.

    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.

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    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...

    Yes I know at least 50 celiacs diagnosed by capsule when standard biopsy and/or blood test was negative.

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    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.

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    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.

    I so agree with you! I was hoping that I'm not getting a little senile.

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    Do patients undergoing the tests have to be eating gluten to test positive?

    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.

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    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 gluten-free 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.

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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