Diagnosis of celiac disease is based on a characteristic enteropathy in an intestinal biopsy and evidence that these changes are gluten-triggered. The appropriate use of simpler and more accurate tools would add reliability to the diagnosis of celiac disease. Thus, the celiac disease-related serology might have a key role in defining new diagnostic standards for celiac disease.
A research article to be published on July 7, 2010 in the World Journal of Gastroenterology addresses this question. A new diagnostic standard based on serology alone could make intestinal biopsy no longer mandatory for diagnosis of celiac disease. With this purpose in mind, a research team from Argentina aimed to establish the diagnostic performance of several serological tests, individually and in combination, for diagnosing celiac disease in patients with different pretest probabilities and to explore potential serological algorithms to reduce the necessity for biopsy.
This study demonstrates that the DGP/tTG Screen assay could be considered as the best initial test for suspected celiac disease. The authors also show that combinations of two serology tests, including the DGP/tTG Screen and IgA a-tTG or IgA a-DGP, might be able to diagnose celiac disease accurately in different clinical scenarios, and that they could diagnose or rule out the disorder, obviating the need for duodenal biopsy in more than 92% of individuals in the high- and low-risk populations.
If future studies validate these findings, new diagnostic strategies for celiac disease could be proposed.
Reference: Sugai E, Moreno ML, Hwang HJ, Cabanne A, Crivelli A, Nachman F, Vázquez H, Niveloni S, Argonz J, Mazure R, La Motta G, Caniggia ME, Smecuol E, Chopita N, Gómez JC, Mauriño E, Bai JC. Celiac disease serology in patients with different pretest probabilities: Is biopsy avoidable? World J Gastroenterol 2010;16(25): 3144-3152
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. firstname.lastname@example.org
Telephone: +5411-43064641 Fax: +5411-43041018
About World Journal of Gastroenterology
World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H. pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2009 IF: 2.092. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.