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Positive Predictive Value of Serological Diagnostic Measures in Celiac Disease


Celiac.com 06/04/2010 - A team of researchers recently set out to assess the positive predictive value of blood test screening for possible cases of celiac disease.

The team included Peter Toftedal, Christian Nielsen, Jonas Trolle Madsen, Kjell Titlestad, Steffen Husby, and Søren Thue Lillevang. They are affiliated with the Hans Christian Andersen Children's Hospital, and the Department of Clinical Immunology of Odense University Hospital in Denmark. P. Toftedal and Ch. Nielsen made contributions to the final published article.

In deciding which possible celiac disease cases might require duodenal biopsy, doctors rely mainly on tests for celiac disease antibodies, such as immunoglobulin A (IgA) anti-tissue transglutaminase (anti-tTG), IgA endomysium antibody (EMA), IgA and IgG anti-gliadin antibodies (IgA and IgG AGA).

For their study, the research team wanted to assess the diagnostic quality of blood testing for possible cases of celiac disease. They did this by performing celiac disease blood tests (IgA and IgG AGA, anti-tTG and EMA) on 11,915 subjects.

They then combined the serological data with clinical data and duodenal biopsy results using a unique Danish personal identification number.

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They found that positive predictive value (PPV) fluctuated in accordance with various combinations of positive celiac disease antibodies. They found the highest predictive value (97.6%) when results for IgA and IgG AGA, anti-tTG and EMA antibodies were all positive.

The team used a logistic regression model at initial blood screening to predict the probability of later biopsy-proven celiac disease in relation to concentrations of IgA AGA and anti-tTG.

They found that anti-tTG concentrations correlated strongly with EMA positivity, number of additional positive antibodies, and higher PPV.

The anti-tTG concentration upon first blood screening for celiac disease was highly informative in relation to EMA positivity, number of additional CD specific antibodies and PPV.

Lastly, results for the high-risk patient group showed that
anti-tTG and IgA AGA concentrations at initial serological screening accurately predicted probability of future biopsy-proven celiac disease.

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1 Response:

 
Sandy
Rating: ratingfullratingfullratingfullratingfullratingempty Unrated
said this on
05 Jun 2010 3:51:28 PM PDT
In other words, false negatives are pretty rare. Blood work is highly predictive of biopsy outcomes. People with elevated AGA IGG alone will not have a positive biopsy. Very interesting!




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If you're going to continue to push for a diagnosis stay on gluten! A break could lead to a false negative. It's a lot harder to go off it and then go back on...

I still prefer steaming, but I wash my white rice throughly. I purchase California rice which has a lower level of arsenic. Moderation is key to most everything! ?

I eat pretty much grain free just fine, I eat fats instead. But on a side note I posted some specialty and grain free options as of late in the food alternative page where I list companies and food product alternatives. I honestly just welcomed bread back into my life, I found a company that makes grain free bread out of nut flours. Given you have to toast the dang bread to use it well but seems to work decently. Pasta there are carb free versions out there, and there are ones made with quinoa, buckwheat, or other grains, I even know one company that makes nut flour based ones. You can get these gluten-free options and avoid the rice. As to levels of arsenic they do test foods for these, and all should be safe, the trace amounts and the sheer amount you would have to eat to get effected is staggering, a bit of rice will not hurt you regardless if your concerned I know gluten-free watchdog does arsenic testing on products you could check and find the "safest ones" for your concerns.

I've forgotten them, just remember the good stuff. Weekends in Baja or Vegas or up Pacific highway to see the Redwoods and Frisco. Watching the sunrise at Mount Soledad and watching it drop into the Pacific in the evening. Carne Asada Burritos on Garnet* Solana beach ale* Gorgeous women entranced by my exotic accent, humboldt county weed, raves at the romper room, *1.99 are you out of your mind Denny Breakfasts, Christmas on the beach, *Beers in the gaslamp quarter. I need one of these * which by the power of my imagination have magically become gluten free AANNNYWAAY... Arsenic in rice. Yeah.

Oh, it definitely struck me as very odd! It also says "no significant increase in intraepithelial lymphocytes". That's their favorite word I guess! My blood work pre-biopsy also showed increase lymphocytes and my primary doctor said it usually means increased inflammation. Doing all the things I can now---filing a complaint, I've emailed my doctors to tell them I'm upset and don't think I received proper care, I'm in the process of trying to see a naturopath that diagnosed a friend of a friend w celiac. I'm going to see if i can get the other blood work done with them---and I've been gluten free for a week and a half!