Duodenal biopsy remains the gold standard for celiac disease (CD) diagnosis. However, it has several pitfalls and requires an invasive procedure in children. In the past few years, a more prominent role for a definitive diagnosis based solely on serology has been proposed. The predictive value of high levels of anti-tissue transglutaminase (tTG) antibodies has also been reported in retrospective CD cohorts. Based on these studies, some authors have proposed to start a gluten-free diet (GFD) for those patients with high tTG antibody levels, without duodenal biopsy. There is no agreement to start a GFD without biopsy to confirm mucosal atrophy. There are age-related differences in CD diagnosis that may be taken into account to evaluate the predictive value of tTG antibody for mucosal atrophy.
A research team, led by Dr. Santiago Vivas from Hospital de Le-n recruited a total of 324 patients with celiac disease (CD; 97 children and 227 adults) prospectively at two tertiary centers. Human IgA class anti-tTG antibody measurement and upper gastrointestinal endoscopy were performed at diagnosis. A second biopsy was performed in 40 asymptomatic adults on a gluten-free diet (GFD) and with normal tTG levels.
Their study will be published on October 14, 2009 in the World Journal of Gastroenterology.