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Is Intestinal Biopsy Avoidable in Diagnosing Celiac Disease?


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Celiac.com 07/14/2010 - Intestinal biopsy is considered the the gold standard for celiac disease testing. However, biopsy is an  invasive procedure and most people would be happy to avoid biopsy all together. Based solely on serology, a new diagnostic standard  has been proposed that would no longer require intestinal biopsy for celiac disease diagnosis in some patients.

Researchers performed duodenal biopsy and serology in six-hundred and seventy-nine adults who were at high risk and low risk for celiac disease. They tested blood samples  to detect antibodies to tissue transglutaminase (tTG) and deamidated gliadin peptide (DGP). The goal of researchers was to establish the diagnostic performance of various serological tests for diagnosing celiac disease in patients with varying pretest results. In this study, they hope to find potential serological algorithms to decrease the requirement for biopsy.

One-hundred and sixty-one consecutive adults with undiagnosed, but suspected intestinal disorders were selected as the high-risk group to be evaluated for celiac disease. Five-hundred and eighteen patients who had been referred for routine upper gastrointestinal endoscopy due to non-specific symptoms such as indigestion, were randomly selected for the low-risk group.

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Prevalence of celiac disease was found in 39.1% of the high-risk group, and 3.3% of the low-risk group. Of the  high-risk patients, all individual assays demonstrated a high diagnostic efficacy, while the low-risk group demonstrated a lower diagnostic efficacy.

The serological findings of this study demonstrated that the algorithm used for individual assays allows patients to avoid biopsy with a negative serology; and positive serology results would require a patient to undergo biopsy. The DGF/tTG Screen assay  may very well be recognized as the best preliminary test for celiac disease. The combination of two tests which include a DGP/tTG screening, may have the ability to  identify celiac disease correctly in various clinical situations, which would allow biopsy to be avoided in the vast majority of cases.

Although the findings were significant for this study, small bowel histology is still deemed the gold standard for accurate celiac disease diagnosis. Further validation of the algorithms is necessary to confirm the findings of this study before new diagnostic guidelines can be considered.

Source:
World J Gastroenterol. 2010 Jul 7;16(25):3144-52.


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3 Responses:

 
CJ Hughes
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said this on
19 Jul 2010 4:20:03 PM PST
Plain English would sure be nice. It sounds to me like the patient who is self-diagnosed needs to start eating gluten again in order to undergo the alternative diagnostic method, like they would for the biopsy. That is just a totally unreasonable requirement. As in - not gonna happen.

 
Courtney
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said this on
20 Jul 2010 6:42:28 PM PST
I concur. What's even more ridiculous, is having to keep eating gluten until after the biopsy. Even with 2 positive blood tests, I must now wait, and suffer, while waiting to be seen by the gastroenterologist. You would think that if the blood came back positive the physicians might speed the process up, so one needs not to suffer.

 
VICKIE
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said this on
18 Aug 2011 4:09:54 PM PST
Well try having the serology negative and the biopsy positive by even a second opinion and then the next time sent to hospital with dehydration from diarrhea and low potassium, etc... and u have yet another invasive test, that they tell you that you do not have CD you have leukocytic colitis caused from the anti-inflammatory drugs they put you on with a second opinion confirming that diagnosis but not ruleing out CD and at follow up with GI doctor. he tells you that all you must have is IBS. What & where do you go then? So what test are actually right or accurate in diagnosing anything? or is it just the doctor?




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