Intestinal Biopsy is not Always Required to Diagnose Celiac Disease

A Retrospective Analysis of Combined Antibody Tests

Annemarie Bürgin-Wolff; Buser Mauro; Hadziselimovic Faruk


BMC Gastroenterol. 2013;13(19) 

In This Article


Celiac disease (CD) is an immune-mediated enteropathy that is caused by intolerance to gluten in genetically susceptible individuals. Its prevalence among the European population is approximately 1%,[1,2] and is even higher among the elderly.[3] Thus, CD is one of the most frequently occurring lifelong diseases. Serological tests to diagnose CD have improved substantially in the last 20 years. In 1998,[4] we proposed a low-risk and cost-effective algorithm to diagnose various forms of gluten-sensitive enteropathy that achieved a positive predictive value (ppv) of 99%, using a combination of different antibody determinations: anti-endomysium (EMA), IgA anti-tissue transglutaminase (IgA anti-tTG), and IgA and IgG anti-native gliadin (IgA and IgG anti-ngli). In a population with a high pretest probability of disease, synchronous determination of three or four CD-specific antibodies has a very high ppv and negative predictive value (npv), and may eliminate the necessity of small-bowel biopsy in many patients suspected of having CD.[4]

In recent years, the use of ngli as an antigen in antibody-detection tests has been replaced with deamidated gliadin peptides (dpgli), which perform better diagnostically than ngli.[5–12] Our goal in this study was to investigate whether using dpgli instead of ngli, alone or in combination with other tests (EMA and IgA anti-tTG), reduces the number of jejunal biopsies without missing CD patients during the diagnostic procedure.