Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2020; 26(26): 3780-3791
Published online Jul 14, 2020. doi: 10.3748/wjg.v26.i26.3780
Non-invasive prediction of persistent villous atrophy in celiac disease
Barbora Packova, Petra Kovalcikova, Zdenek Pavlovsky, Daniel Bartusek, Jitka Prokesova, Jiri Dolina, Radek Kroupa
Barbora Packova, Jitka Prokesova, Jiri Dolina, Radek Kroupa, Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
Petra Kovalcikova, Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
Zdenek Pavlovsky, Department of Pathology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
Daniel Bartusek, Department of Radiology and Nuclear Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
Author contributions: Packova B was involved in the conceptualization, data collection, investigation, project administration, writing original draft; Kovalcikova P took part in methodology and was responsible for statistical analysis; Pavlovsky Z was involved in the data collection, investigation; writing review and editing; Bartusek D was involved in the data collection, investigation; writing review and editing; Prokesova J was involved in the data collection, writing review and editing ; Dolina J took part in the supervision and editing; Kroupa R performed the conceptualization, methodology, project administration, supervision, validation, visualization, writing review and editing. All authors have read and approve the final manuscript.
Supported by Ministry of Health, Czech Republic – conceptual development of research organization, No. FNBr, 65269705.
Institutional review board statement: The study protocol was approved by Institutional review board University hospital Brno.
Informed consent statement: All the patients signed informed consent.
Conflict-of-interest statement: The authors do not have any conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Radek Kroupa, MD, PhD, Doctor, Research Assistant Professor, Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavska 20, Brno 62500, Czech Republic. kroupa.radek@fnbrno.cz
Received: January 16, 2020
Peer-review started: January 16, 2020
First decision: April 8, 2020
Revised: May 13, 2020
Accepted: July 1, 2020
Article in press: July 1, 2020
Published online: July 14, 2020
ARTICLE HIGHLIGHTS
Research background

Currently, duodenal biopsy is the only way to evaluate mucosal healing in celiac disease (CD). There is no reliable widely available non-invasive marker of persistent villous atrophy (VA), which is one of the core pathological signs of active CD.

Research motivation

There is ongoing attempt to search for non-invasive markers for mucosal healing in CD, as persistent VA is one of the risk factors for malignant complications and possibly higher mortality rates in CD.

Research objectives

Closer analysis of currently available non-invasive CD relevant markers, such as the exact value of anti-tissue transglutaminase antibodies (aTTG), anti-deamidated gliadin peptide antibodies (aDGP), or combination with ultrasonographic signs of active CD could help in prediction of persistent VA.

Research methods

We analyzed data from the database of patients with CD followed-up at the Department of Gastroenterology and Internal Medicine, University Hospital Brno from 2014 to 2018. The symptoms, laboratory signs, exact values of aTTG, aDGP, ultrasonographic signs of active CD were correlated to persistent VA.

Research results

Calculation of new cut-off values of aTTG and aDGP IgA improved the sensitivity, specificity, and negative predictive value for VA. The combination with expert bowel ultrasound examination achieved even better accuracy.

Research conclusions

We found out that a combination of currently available non-invasive CD relevant markers could help in prediction of persistent VA.

Research perspectives

This could lead to more personalized approaches and closer follow-ups of CD patients, including repeated evaluation of adherence to GFD, thorough searches for nutritional deficiencies and possibly also follow-up duodenal biopsy and search for complications of CD.