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A Systematic Review of Diagnostic Testing for Celiac Disease Among Patients With Abdominal Symptoms 06/03/2010 - Clinical presentation of celiac disease can vary considerably from patient to patient. Most patients with celiac disease present atypical symptoms. Moreover, most patients who present abdominal symptoms in primary care do not have celiac disease, and so diagnostic tests for celiac disease are not necessary and should be avoided.

A team of researchers recently conducted a systematic review of diagnostic testing for celiac disease among patients with abdominal symptoms.

The team included Daniëlle A. W. M. van der Windt, PhD; Petra Jellema, PhD; Chris J. Mulder, MD, PhD; C. M. Frank Kneepkens, MD, PhD; and Henriëtte E. van der Horst, MD, PhD. Their article appears in the Journal of the American Medical Association.

The goal of the research was to review and summarize evidence on the performance of diagnostic tests for spotting celiac disease in adults who present abdominal symptoms in primary care or similar settings.

To obtain initial data, the team search MEDLINE (from January 1966  through December 2009, and EMBASE from January 1947 through December 2009. They also conducted a physical search of references for additional relevant studies.

The team chose cohort or nested case-control diagnostic studies which included adults presenting non-acute abdominal symptoms, which featured celiac disease prevalence of 15% or less, and in which the tests included gastrointestinal symptoms or serum antibody screens.

Two independent reviewers conducted studies tool and data extraction. They then calculated sensitivities and specificities for each study and computed pooled estimates using bivariate analysis where there was clinical and statistical homogeneity.

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In all, the team included sixteen studies encompassing 6085 cases in their review.

Specificity, sensitivity, and confidence intervals for predicting celiac disease varied with abdominal symptoms.  For patients presenting with classic diarrhea, for example, predictive sensitivity ranged from 0.27 to 0.86, while specificity ranged from 0.21 to 0.86.

Pool estimates for 8 studies on IgA antiendomysial antibodies were 0.90, with a 95% confidence interval [CI] (0.80-0.95) for sensitivity and 0.99, with a 95% CI (0.98-1.00) for specificity, with a positive likelihood ratio [LR] of 171 and negative LR of 0.11.

Pool estimates for IgA antitissue transglutaminase antibodies (7 studies) were 0.89, with a 95% CI (0.82-0.94) and 0.98 at 95% CI (0.95-0.99), respectively, with a positive LR of 37.7 and negative LR of 0.11.

IgA and IgG antigliadin antibodies showed variable results, especially for sensitivity, which ranged from 0.46-0.87 for IgA, and from 0.25-0.93 for IgG.

One recent study using deamidated gliadin peptides showed good specificity (0.94), but the target population offered limited supporting evidence.

For adults who present abdominal symptoms in primary care or other unscreened settings, IgA antitissue transglutaminase antibodies and IgA antiendomysial antibodies offer high sensitivity and specificity for diagnosing celiac disease.

SOURCE:  JAMA. 2010;303(17):1738-1746. doi:10.1001/jama.2010.549 welcomes your comments below (registration is NOT required).

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3 Responses:

Craig J Brown
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said this on
07 Jun 2010 4:37:41 AM PDT
I see lots of patients that have severe gluten sensitivity and family histories of celiac and positive genetics that fail their criteria, who find a gluten-free diet life changing. Another recent study took 36 of these "negatives" gave them a high gluten challenge for a month.

1/3 nothing happened
1/3 suddenly had classic lesions on biopsy
1/3 were still negative but so sick that they embraced a gluten-free diet afterward.

The error here is that they will only diagnose celiac Disease if the biopsy is positive. Europe is moving past that stumbling block, the US has not, yet.

antonio de souza
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said this on
21 Aug 2010 7:37:48 AM PDT

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said this on
04 Oct 2011 10:07:49 AM PDT
In May of 2010 I found myself being admitted to the hospital for severe abdominal cramping and pain, blood in my stool, and blood in my stomach bile when I was throwing up. After a week, in the hosp and a colonoscopy, the Dr. said I had mild/severe colitis, and to avoid all fresh fruits and veggies, especially anything that would encourage gas and bloating. I followed his advice and instead of getting better it got worse. Having moved from the area, and husband having lost his job, and our having no money, having lost my sister to a liver cancer (whole other story there) I was becoming very afraid when my symptoms began to get worse.(I never ever really felt 'good'. I decided to keep a food journal. After doing some online research, I decided to go GF, and by the second day, the change was shocking. It has been 3 months, and tho I am still learning, I feel SO much better! I still have occasional issues, but that is usually when I find myself using dairy. So maybe I will discover I am lactose intolerant as well. Discovering that I may not have to go back to gluten to verify whether I have celiac or not worries me, but after reading this, I may not have to. I am glad I have this comprehensive site that helps me make decisions.

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Wish we could see her follow up studies from the last 5 years.

Thank you, Awol cast iron stomach. It's really hard to tell which ingredient(s) is the wrong one for me. I think I'll eliminate all additives as much as possible because they are unhealthy anyway and then if that doesn't work I'll eliminate corn and dairy, too.

Has anyone ever experienced issues with Bob's Red Mill products? I've noticed that their products are not certified gluten free or at least that's my assumption after reading the packages.

Odd. And I wonder why she thinks she doesn't have Celiac? But her little experiment does show that some people may be going over board with new and separate pots, etc

Interesting article. I do wonder how she was 'misdiagnosed' though and how she came to the conclusion she wasn't celiac.