A “no-biopsy” approach to diagnosing celiac disease

Abstract

A "no-biopsy" approach to diagnosing celiac disease This noninvasive alternative to the diagnostic gold standard may cut risk and expense for adult patients. PRACTICE CHANGERConsider a "no-biopsy" approach by evaluating serum immunoglobulin (Ig) A anti-tissue transglutaminase (tTG-IgA) antibody titers in adult patients who present with symptoms concerning for celiac disease (CD). An increase of ≥ 10 times the upper limit of normal (ULN) for tTG-IgA has a positive predictive value (PPV) of ≥ 95% for diagnosing CD when compared with esophagogastroduodenoscopy (EGD) with duodenal biopsy-the current gold standard. STRENGTH OF RECOMMENDATIONA: Consistent findings from 3 good-quality diagnostic cohorts presented in a single study. 1

Insights into coeliac disease diagnosis: a 2021–2023 overview of diagnostic approach and delays in children in Slovenia

“…In recent years, there has been notable exploration of the no-biopsy approach for diagnosing coeliac dis-ease in adult populations [14][15][16]. Initial concerns about omitting biopsy, particularly in adults, due to potential risks of missing significant concomitant conditions including malignancy, have been addressed by recent studies from Italy and England [16,[19][20][21][22]. Interestingly, recent guidelines from the American College for Gastroenterology have proposed the use of a no-biopsy approach for diagnosing coeliac disease in children under specific circumstances [13].…”