A Biopsy Is Not Always Necessary to Diagnose Celiac Disease
- 1 May 2011
- journal article
- research article
- Published by Wiley in Journal of Pediatric Gastroenterology and Nutrition
- Vol. 52 (5), 554-557
- https://doi.org/10.1097/mpg.0b013e3181ef8e50
Abstract
Objectives: Small intestinal histology is the criterion standard for the diagnosis of celiac disease (CD). However, results of serological tests such as anti-endomysium antibodies and anti-tissue transglutaminase antibodies (tTGA) are becoming increasingly reliable. This raises the question of whether a small intestinal biopsy is always necessary. The aim of the present study was, therefore, to investigate whether a small intestinal biopsy can be avoided in a selected group of patients. Patients and Methods: Serology and histological slides obtained from 283 pediatric patients suspected of having CD were examined retrospectively. The response to a gluten-free diet (GFD) in patients with a tTGA level ≥100 U/mL was investigated. Results: A tTGA level ≥100 U/mL was found in 128 of the 283 patients. Upon microscopic examination of the small intestinal epithelium, villous atrophy was found in 124 of these patients, confirming the presence of CD. Three patients had crypt hyperplasia or an increased number of intraepithelial lymphocytes. In 1 patient no histological abnormalities were found. This patient did not respond to a GFD. Conclusions: Pediatric patients with a tTGA level ≥100 U/mL in whom symptoms improve upon consuming a GFD may not need a small intestinal biopsy to confirm CD.This publication has 41 references indexed in Scilit:
- Serum and Intestinal Celiac Disease–associated Antibodies in Children With Celiac Disease Younger Than 2 Years of AgeJournal of Pediatric Gastroenterology and Nutrition, 2010
- Performance of Serology Assays for Diagnosing Celiac Disease in a Clinical SettingClinical and Vaccine Immunology, 2009
- Antigliadin Immunoglobulin A Best in Finding Celiac Disease in Children Younger Than 18 Months of AgeJournal of Pediatric Gastroenterology and Nutrition, 2008
- What Is the Role of Serologic Testing in Celiac Disease? A Prospective, Biopsy-Confirmed Study With Economic AnalysisClinical Gastroenterology and Hepatology, 2008
- Strongly Positive Tissue Transglutaminase Antibodies are Associated With Marsh 3 Histopathology in Adult and Pediatric Celiac DiseaseJournal of Clinical Gastroenterology, 2008
- The Absence of a Mucosal Lesion on Standard Histological Examination Does Not Exclude Diagnosis of Celiac DiseaseDigestive Diseases and Sciences, 2007
- Affinity maturation of immunoglobulin A anti-tissue transglutaminase autoantibodies during development of coeliac diseaseClinical and Experimental Immunology, 2007
- Is immunoglobulin A anti-tissue transglutaminase antibody a reliable serological marker of coeliac disease?European Journal of Gastroenterology & Hepatology, 2004
- A prospective study of the incidence of childhood celiac diseaseThe Journal of Pediatrics, 2003
- The coeliac iceberg in Italy. A multicentre antigliadin antibodies screening for coeliac disease in school‐age subjectsActa Paediatrica, 1996