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Multicenter Study
. 2024 Mar;39(3):489-495.
doi: 10.1111/jgh.16436. Epub 2023 Dec 14.

Validation of no-biopsy pathway for the diagnosis of celiac disease in Asian adults: a multicenter retrospective study

Aditya Vikram Pachisia  1 , Alka Kumari  1 , Shubham Mehta  1 , Anam Ahmed  1 , Ashish Chauhan  1 , Ankit Agarwal  1 , Vignesh Dwarkanathan  2 , Sachin Rajpoot  1 , Shubham Prasad  1 , Sanjay Kumar  3 , Saroj Kant Sinha  3 , Divya Sharma  4 , Mahender Rajput  1 , Prasenjit Das  5 , Sushil Falodia  4 , Rakesh Kochhar  3 , B S Ramakrishna  6 , Vineet Ahuja  1 , Govind Makharia  1
Affiliations
Multicenter Study

Validation of no-biopsy pathway for the diagnosis of celiac disease in Asian adults: a multicenter retrospective study

Aditya Vikram Pachisia et al. J Gastroenterol Hepatol. 2024 Mar.

Abstract

Background and aim: While European Society of Pediatric Gastroenterology Hepatology and Nutrition advocates a no-biopsy pathway for the diagnosis of celiac disease (CeD) in children if IgA anti-tissue transglutaminase antibody (anti-tTG ab) titer is ≥10-fold upper limit of normal (ULN) and have a positive IgA anti-endomysial antibody (EMA); the data for anti-tTG Ab titer-based diagnosis of CeD in adults is still emerging. We planned to validate if IgA anti-tTG Ab titer ≥10-fold predicts villous abnormalities of modified Marsh grade ≥2 in Asian adult patients with CeD.

Methods: We recruited 937 adult patients with positive anti-tTG Ab from two databases, including AIIMS Celiac Clinic and Indian National Biorepository. The diagnosis of definite CeD was made on the basis of a positive anti-tTG Ab and the presence of villous abnormalities of modified Marsh grade ≥2.

Results: Of 937 adult patients with positive anti-tTG Ab, 889 (91.2%) showed villous abnormalities of modified Marsh grade ≥2. Only 47.6% of 889 adults with CeD had anti- tTG Ab titers of ≥10-fold. The positive predictive value (PPV) and specificity of anti tTG Ab titer ≥10-fold for predicting modified Marsh grade ≥2 were 99.8% and 98%, respectively. At anti-tTG Ab titer ≥11-fold, specificity and PPV were 100% for predicting villous abnormalities of modified Marsh grade ≥2.

Conclusions: Approximately 50% of adults with CeD may benefit from the no biopsy pathway, reducing the health burden and risks of gastroscopy/anesthesia.

Keywords: Anti-tissue transglutaminase antibody; Diagnosis; Modified Marsh grade; Serology; Villous abnormalities.

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References

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