Accuracy of a no-biopsy approach for the diagnosis of coeliac disease across different adult cohorts

Penny, Hugo A and Raju, Suneil A and Lau, Michelle S and Marks, Lauren JS and Baggus, Elisabeth MR and Bai, Julio C and Bassotti, Gabrio and Bontkes, Hetty J and Carroccio, Antonio and Danciu, Mihai and Derakhshan, Mohammad H and Ensari, Arzu and Ganji, Azita and Green, Peter H R and Johnson, Matt W and Ishaq, Sauid and Lebwohl, Benjamin and Levene, Adam and Maxim, Roxana and Mohaghegh Shalmani, Hamid and Rostami-Nejad, Mohammad and Rowlands, David and Spiridon, Irene A and Srivastava, Amitabh and Volta, Umberto and Villanacci, Vincenzo and Wild, Graeme and Cross, Simon S and Rostami, Kamran and Sanders, David S (2020) Accuracy of a no-biopsy approach for the diagnosis of coeliac disease across different adult cohorts. Gut. ISSN 1468-3288

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Abstract

Objective: We aimed to determine the predictive capacity and diagnostic yield of a 10-fold increase in serum IgA antitissue transglutaminase (tTG) antibody levels for detecting small intestinal injury diagnostic of coeliac disease (CD) in adult patients. Design: The study comprised three adult cohorts. Cohort 1: 740 patients assessed in the specialist CD clinic at a UK centre; cohort 2: 532 patients with low suspicion for CD referred for upper GI endoscopy at a UK centre; cohort 3: 145 patients with raised tTG titres from multiple international sites. Marsh 3 histology was used as a reference standard against which we determined the performance characteristics of an IgA tTG titre of ≥10×ULN for a diagnosis of CD. Results: Cohort 1: the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for IgA tTG levels of ≥10×ULN at identifying individuals with Marsh 3 lesions were 54.0%, 90.0%, 98.7% and 12.5%, respectively. Cohort 2: the sensitivity, specificity, PPV and NPV for IgA tTG levels of ≥10×ULN at identifying individuals with Marsh 3 lesions were 50.0%, 100.0%, 100.0% and 98.3%, respectively. Cohort 3: the sensitivity, specificity, PPV and NPV for IgA tTG levels of ≥10×ULN at identifying individuals with Marsh 3 lesions were 30.0%, 83.0%, 95.2% and 9.5%, respectively. Conclusion: Our results show that IgA tTG titres of ≥10×ULN have a strong predictive value at identifying adults with intestinal changes diagnostic of CD. This study supports the use of a no-biopsy approach for the diagnosis of adult CD.

Item Type: Article
Additional Information: ** Embargo end date: 02-11-2020 ** From BMJ via Jisc Publications Router ** History: received 15-02-2020; rev-recd 29-06-2020; accepted 18-07-2020; ppub 11-2020; epub 02-11-2020. ** Licence for this article starting on 02-11-2020: http://creativecommons.org/licenses/by-nc/4.0/
Identification Number: https://doi.org/10.1136/gutjnl-2020-320913
Date: 2 November 2020
Uncontrolled Keywords: Coeliac disease
Subjects: A300 Clinical Medicine
Divisions: Faculty of Health, Education and Life Sciences > School of Health Sciences
REF UoA Output Collections > REF2021 UoA 03: Allied Health Professions, Dentistry, Nursing & Pharmacy
SWORD Depositor: JISC PubRouter
Depositing User: JISC PubRouter
Date Deposited: 18 Dec 2020 11:45
Last Modified: 07 Jan 2021 14:13
URI: http://www.open-access.bcu.ac.uk/id/eprint/10238

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