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Celiac disease serology in patients with different pretest probabilities: Is biopsy avoidable?
Emilia Sugai, María L Moreno, Hui J Hwang, Ana Cabanne, Adriana Crivelli, Fabio Nachman, Horacio Vázquez, Sonia Niveloni, Julio Argonz, Roberto Mazure, Graciela La Motta, María E Caniggia, Edgardo Smecuol, Néstor Chopita, Juan C Gómez, Eduardo Mauriño, Julio C Bai
Emilia Sugai, María L Moreno, Hui J Hwang, Fabio Nachman, Horacio Vázquez, Sonia Niveloni, Roberto Mazure, Edgardo Smecuol, Eduardo Mauriño, Julio C Bai, Small Bowel Section, Department of Medicine, Gastroenterology Hospital “Dr. C. Bonorino Udaondo”, Caseros 2061, Ciudad de Buenos Aires, Argentina
Ana Cabanne, Pathology Service, Hospital de Gastroenterología “Dr. C. Bonorino Udaondo”, Av. Caseros 2061, Ciudad de Buenos Aires, Argentina
Adriana Crivelli, Graciela La Motta, María E Caniggia, Juan C Gómez, USNMA, HIGA “San Martín”, La Plata; B1900, Provincia de Buenos Aires, Argentina
Julio Argonz, Endoscopy Service, Hospital de Gastroenterología “Dr. C. Bonorino Udaondo”, Av. Caseros 2061, Ciudad de Buenos Aires, Argentina
Néstor Chopita, Endoscopy Service, HIGA “San Martín”, La Plata; B1900, Provincia de Buenos Aires, Argentina
Author contributions: Sugai E, Mauriño E, Gómez JC and Bai JC made substantial contributions to the conception, design, drafting and critical revision of the article for important intellectual content; Caniggia ME and Vázquez H analyzed the data; Moreno ML, Hwang HJ, Crivelli A, Nachman F, Niveloni S, Argonz J, Mazure R, La Motta GL, Chopita N and Smecuol E contributed to patient collection, endoscopic procedures, data acquisition analysis, and interpretation; Cabanne A performed the histopathological analysis; all authors approved the published version.
Supported by (in part) A Grant from the Consejo de Investigación en Salud del Ministerio de Salud del Gobierno Autónomo de la Ciudad de Buenos Aires, Argentina
Correspondence to: Julio C Bai, MD, Professor, Small Bowel Section, Department of Medicine, Gastroenterology Hospital “Dr. C. Bonorino Udaondo”, Av. Caseros 2061, Ciudad de Buenos Aires, Argentina. jbai@intramed.net
Telephone: + 5411-43064641 Fax: + 5411-43041018
Received: February 4, 2010
Revised: March 22, 2010
Accepted: March 29, 2010
Published online: July 7, 2010
AIM: To establish the diagnostic performance of several serological tests, individually and in combination, for diagnosing celiac disease (CD) in patients with different pretest probabilities, and to explore potential serological algorithms to reduce the necessity for biopsy.
METHODS: We prospectively performed duodenal biopsy and serology in 679 adults who had either high risk (n = 161) or low risk (n = 518) for CD. Blood samples were tested using six assays (enzyme-linked immunosorbent assay) that detected antibodies to tissue transglutaminase (tTG) and deamidated gliadin peptide (DGP).
RESULTS: CD prevalence was 39.1% in the high-risk population and 3.3% in the low-risk group. In high-risk patients, all individual assays had a high diagnostic efficacy [area under receiving operator characteristic curves (AU ROC): 0.968 to 0.999]. In contrast, assays had a lower diagnostic efficacy (AU ROC: 0.835 to 0.972) in the low-risk group. Using assay combinations, it would be possible to reach or rule out diagnosis of CD without biopsy in 92% of cases in both pretest populations. We observed that the new DGP/tTG Screen assay resulted in a surplus compared to more conventional assays in any clinical situation.
CONCLUSION: The DGP/tTG Screen assay could be considered as the best initial test for CD. Combinations of two tests, including a DGP/tTG Screen, might be able to diagnose CD accurately in different clinical scenarios making biopsy avoidable in a high proportion of subjects.
