Serology-based criteria for adult coeliac disease have excellent accuracy across the range of pre-test probabilities

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Fuchs , V , Kurppa , K , Huhtala , H , Laurila , K , Maki , M , Collin , P , Salmi , T , Luostarinen , L , Saavalainen , P & Kaukinen , K 2019 , ' Serology-based criteria for adult coeliac disease have excellent accuracy across the range of pre-test probabilities ' , Alimentary Pharmacology & Therapeutics , vol. 49 , no. 3 , pp. 277-284 . https://doi.org/10.1111/apt.15109

Title: Serology-based criteria for adult coeliac disease have excellent accuracy across the range of pre-test probabilities
Author: Fuchs, Valma; Kurppa, Kalle; Huhtala, Heini; Laurila, Kaija; Maki, Markku; Collin, Pekka; Salmi, Teea; Luostarinen, Liisa; Saavalainen, Paivi; Kaukinen, Katri
Contributor: University of Helsinki, HYKS erva
University of Helsinki, Immunobiology Research Program
Date: 2019-02
Language: eng
Number of pages: 8
Belongs to series: Alimentary Pharmacology & Therapeutics
ISSN: 0269-2813
URI: http://hdl.handle.net/10138/311292
Abstract: Background The revised paediatric criteria for coeliac disease allow omission of duodenal biopsies in symptomatic children who have specific serology and coeliac disease-associated genetics. It remains unclear whether this approach is also applicable for adults with various clinical presentations. Aim To evaluate the accuracy of serology-based criteria in adults with variable pre-test probabilities for coeliac disease. Methods Three study cohorts comprised adults with high-risk clinical coeliac disease suspicion (n = 421), moderate-risk family members of coeliac disease patients (n = 2357), and low-risk subjects from the general population (n = 2722). Serological and clinical data were collected, and "triple criteria" for coeliac disease comprised transglutaminase 2 antibodies >10x the upper limit of normal, positive endomysium antibodies, and appropriate genetics without requirement of symptoms. The diagnosis was based on intestinal biopsy. Results The diagnosis of coeliac disease was established in 274 subjects. Of these, 59 high-risk subjects, 17 moderate-risk subjects, and 14 low-risk subjects fulfilled the "triple criteria". All had histologically proven coeliac disease, giving the criteria a positive predictive value of 100%. Altogether, 90 (33%) of all 274 newly diagnosed patients could have avoided biopsy, including 37% among high-risk, 20% among moderate-risk, and 48% among low-risk patients. No histological findings other than coeliac disease were found in the biopsies of "triple positive" subjects. Conclusions Coeliac disease can reliably and safely be diagnosed without biopsy in adults fulfilling the "triple criteria" regardless of the pre-test probability. Revised criteria would enable the number of endoscopies to be reduced by one-third.
Subject: TISSUE-TRANSGLUTAMINASE ANTIBODIES
PRIMARY-CARE
BIOPSY
PREVALENCE
GUIDELINES
DIAGNOSIS
CHILDREN
ENTEROPATHY
MANAGEMENT
SYMPTOMS
3121 General medicine, internal medicine and other clinical medicine
3111 Biomedicine
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