<<Disclaimer: Verify this information before applying it to your situation.>>

This article answers a frequent question seen on the Celiac List:

Am J Gastroenterol. 2003 Jun;98(6):1325-31

Is intestinal biopsy always needed for diagnosis of celiac disease?

Scoglio R, Di Pasquale G, Pagano G, Lucanto MC, Magazzu G, Sferlazzas C.

Department of Pediatrics, GI Unit, University of Messina, Messina, Italy

Intestinal biopsy is required for a diagnosis of celiac disease (CD). The
aim of this study was to assess diagnostic accuracy of transglutaminase
antibodies (TGA) in comparison and in association with that of
antiemdomysial antibodies (AEA), calculating the post-test odds of having
the disease, to verify whether some patients might avoid undergoing
intestinal biopsy for a diagnosis of CD.A total of 181 consecutive patients
(131 < 18 yr), referred to our celiac clinic by primary care physicians for
suspect CD. Overall diagnostic accuracy, negative predictive value, and
likelihood ratio (LR) were calculated both for each serological test and
for serial testing (TGA and after AEA, assuming the post-test probability
of TGA as pretest probability of AEA). Both serological determination and
histological evaluation were blindly performed. Histology of duodenal
mucosa was considered the gold standard.The overall accuracy of TGA and of
AEA were 92.8% (89.1-96.6) and 93.4% (89.7-97.0), respectively. The
negative predictive value of TGA and AEA were 97.2% (91.9-102.6) and 87.2%
(77.7-96.8), respectively. Positive likelihood ratios for TGA and AEA were
3.89 (3.40-4.38) and 7.48 (6.73-8.23), respectively. Serial testing, in
groups of patients with prevalence of CD estimated higher than 75%, such as
those with classic symptoms of CD, would provide a post-test probability of
more than 99%.Our results suggest that serial testing with TGA and AEA
might allow, in some cases, the avoidance of intestinal biopsy to confirm
the diagnosis of CD.

*Support summarization of posts, reply to the SENDER not the Celiac List*