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Original research
Is duodenal biopsy always necessary for the diagnosis of coeliac disease in adult patients with high anti-tissue transglutaminase (TTG) antibody titres?
  1. Junaid Beig1,
  2. Kamran Rostami2,
  3. David T S Hayman3,
  4. Summer Hassan1,
  5. Stephen Gerred1,
  6. Ravinder Ogra1
  1. 1Gastroenterology and Hepatology, Middlemore Hospital - Counties Manukau DIstrict Health Board (CMDH), Auckland, New Zealand
  2. 2Gastroenterology and Hepatology, MidCentral District Health Board, Palmerston North, New Zealand
  3. 3Molecular Epidemiology and Public Health Laboratory, School of Veterinary Science, Massey University, Palmerston North, New Zealand
  1. Correspondence to Dr Junaid Beig, Gastroenterology and Hepatology, Waikato District Health Board, Hamilton, New Zealand; drjunaidyaseen{at}gmail.com

Abstract

Objective Avoiding duodenal biopsy in adults for coeliac disease (CD) diagnosis is controversial. Some retrospective and prospective studies have shown that CD can be reliably diagnosed in adults with serology rather than duodenal biopsies. This study aimed to check the accuracy of a cut-off value of ≥10 upper limit of normal of anti-tissue transglutaminase antibody (anti-TTG IgA) titres for CD diagnosis in adult patients.

Method We retrospectively analysed adult patients (≥16 years) who underwent gastroscopy from 2013 to 2018 for positive coeliac serology. The relationship between titres and disease was determined by using linear models, whereas sensitivity and specificity were assessed by receiver operator curve.

Results We analysed 144 newly anti-TTG antibody-positive adult patients with a median age of 48.5 years (IQR 32–62); among them, 86 (60%) patients had CD (Marsh III: n=68 and Marsh II and I: n=18) with a higher prevalence in females (n=59 (69%)) and Europeans (n=60 (70%)). Fifty (58%) patients with CD had colonoscopy and five (6%) had imaging; only six patients were diagnosed with additional conditions. An anti-TTG IgA titre cut-off value of 150 U/L was 100% specific for CD in our dataset, with 70% (95% CI: 60% to 88%) sensitivity for this patient group.

Conclusion Coeliac serology using anti-TTG IgA with titres ≥10× normal value is an excellent predictor of CD, irrespective of age, gender and ethnicity. Duodenal biopsy may not be necessary in selected adult patients with CD, especially younger than 50 years of age without additional gastrointestinal red-flag signs and symptoms.

  • celiac disease
  • small intestinal biopsy

Data availability statement

Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available upon reasonable request. Restrictions apply to the availability of data from JB with the permission of Counties Manukau Health Research Office.

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Data availability statement

Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available upon reasonable request. Restrictions apply to the availability of data from JB with the permission of Counties Manukau Health Research Office.

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Footnotes

  • Contributors All authors made significant contributions to the design, acquisition of data, analysis and interpretation of data. All took part in drafting and revising the manuscript. All authors read and approved the final manuscript. JB collected data, analysed the data and wrote the manuscript. KR provided the idea for the study and assisted in reviewing the manuscript. SH helped in data collection. DH did the statistical analysis and manuscript editing. SG provided data and helped in manuscript editing. RO supervised the study and assisted in manuscript editing.

  • Funding DTSH is funded by Royal Society Te Apārangi, grant number MAU1701.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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