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  • Jefferson Adams
    Jefferson Adams

    Simple Three Point Criteria Can Spot Celiac Disease in Adults Without Biopsy

    Reviewed and edited by a celiac disease expert.

      New research shows that the “triple criteria” can be used by doctors to reliably spot celiac disease in adults without using biopsy. 


    Caption: Image: CC--University of the Fraser Valley

    Celiac.com 01/29/2019 - Serology-based criteria for adult celiac disease have excellent pre-test accuracy, but can they be helpful in spotting celiac disease without biopsy? New criteria for diagnosing celiac disease in children allow doctors to forgo duodenal biopsies in children who have symptoms, positive blood tests, and celiac disease-associated genes. However, there’s currently no good data on whether such an approach might work for adults with certain clinical presentations of celiac disease.

    A team of researchers recently set out to evaluate the accuracy of serology-based criteria in adults with variable pre-test probabilities for celiac disease.


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    The Finnish research team included V Fuchs, K Kurppa, H Huhtala, K Laurila, M Mäki, P Collin, T Salmi, L Luostarinen, P Saavalainen, and K Kaukinen. 

    The team compiled three study groups, including 421 adults with high-risk clinical celiac disease suspicion, 2,357 moderate-risk family members of celiac patients, and 2,722 low-risk individuals from the general population. 

    They collected blood tests and other physical patient data. Their "triple criteria" for celiac disease included transglutaminase 2 antibodies more than ten times the upper limit of normal, positive endomysium antibodies, and appropriate genetics, but required no symptoms. The diagnosis was made by grading the intestinal biopsies.

    Can a Biopsy be Avoided when Diagnosing Celiac Disease?

    In all, 274 patients were diagnosed with celiac disease. Of these, 59 high-risk subjects, 17 moderate-risk subjects, and 14 low-risk subjects fulfilled the "triple criteria.” 

    All had histologically proven celiac disease, giving the criteria a positive predictive value of 100%. Altogether, 90 of the 274 newly diagnosed patients could have avoided biopsy. That’s one in three patients who could have avoided biopsy. In all, 37% of high-risk, 20% of moderate-risk, and 48% of low-risk patients could have avoided biopsy. 

    Biopsies of "triple positive" subjects showed no histological findings other than celiac disease. The results of this study are exciting, because they show that the “triple criteria” can be used by doctors to reliably spot celiac disease in adults without using biopsy. 

    Implementing these diagnostic criteria would make diagnosing celiac disease easier in many cases, and will reduce the number of endoscopies by one-third. That’s a winning result all the way around.

    Read more at: Aliment Pharmacol Ther. 2018 Dec 27. doi: 10.1111/apt.15109.


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    I’d like to know how many people who are gluten “intolerant” but have celiac genes might be Glutamate Dominant. I’ve been learning more about this condition and what “turns it off.” Apparently we all need “some glutamate” in our brains for cognition, however it can become a problem if the transition to GABA doesn’t occur. There is literature to support avoiding MSG, high glutamate diets- and glutamate is naturally in wheat and many grains except rice. What if that is the bigger picture when the neurological conditions arise? MSG can lead to seizures, and so can glutamate dominance. Boosting B6, magnesium glycinate, GABA and glycine is said to help set the system in balance again.

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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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