Certain adult patients with suspected coeliac disease might not require invasive endoscopy and duodenal biopsy for an accurate diagnosis, data suggest.
The UK researchers said their systematic review and meta-analysis was the first to evaluate the accuracy of the no-biopsy approach, which could lead to shorter diagnosis times, increased patient satisfaction and reduced healthcare costs.
They found that IgA anti-tissue transglutaminase (tTg) antibody levels of 10 or more times the upper limit of normal (ULN) were highly indicative of coeliac disease in adults with a 100% specificity and a positive predictive value of 98%.
Although the value varied according to the pre-test probability of coeliac disease.
The meta-analysis involved 18 studies of more than 12,000 participants from 15 countries, with a pooled prevalence of biopsy-proven coeliac disease of 62%.
The proportion of patients with IgA-tTG ≥10×ULN was 32%.
Results showed that the overall summary sensitivity of IgA-tTG ≥10×ULN was 51% and the summary specificity was 100% for the detection of coeliac disease. The area under the summary receiver operating characteristic curve was 0.83.
The positive predictive value of the no-biopsy approach was 65%, 88%, 95%, and 99% if coeliac disease prevalence was 1%, 4%, 10% and 40%, respectively.
The results suggested that select adult patients who met the very high antibody levels and had a moderate to high pre-test probability of coeliac disease could be diagnosed without undergoing further invasive investigations, the researchers said.