No-biopsy pathway following the interim BSG guidance reliably diagnoses adult coeliac disease

Recent interim guidance from the British Society of Gastroenterology, aligned to historical paediatric practice, advises a no-biopsy protocol (NBP) for adults with high anti-tissue transglutaminase (tTG-IgA) titres and other clinical factors. A 7-year retrospective review identified 433 patients with positive tTG-IgA. Of these 433, 98 (23%) fulfilled the high titre criteria for an NBP which may have reduced endoscopic burden on the service. A high titre versus low titre translated in a 95% versus 75% histological confirmation of coeliac disease (p<0.01). The addition of anti-endomysial antibody analyses impacted minimally on these predictive rates. Our data support an NBP approach for selected patients. Of concern, however, was the finding that a third of patients with positive titres were not referred for a biopsy despite national guidance at the time advocating it. A clear message needs to be transmitted that the NBP is only for those with high titre, as opposed to any tTG-IgA positivity.

Download Full-text

Symposium 1: Joint BAPEN and British Society of Gastroenterology Symposium on ‘Coeliac disease: basics and controversies’ Coeliac disease in the twenty-first century

Proceedings of The Nutrition Society ◽

10.1017/s0029665109001414 ◽

2009 ◽

Vol 68 (3) ◽

pp. 234-241 ◽

Cited By ~ 8

Author(s):

William Dickey

Keyword(s):

Coeliac Disease ◽

Villous Atrophy ◽

Tissue Transglutaminase ◽

Disease Process ◽

Histological Change ◽

Intraepithelial Lymphocytes ◽

British Society ◽

Serological Testing ◽

Multisystem Disorder ◽

Number Of Patients

Coeliac disease (CD), traditionally perceived as a rare childhood condition presenting with malabsorption, is instead an autoimmune multisystem disorder usually presenting in adulthood, affecting ⩾1% of the population and linked to the genetic expression of human leucocyte antigens (HLA) DQ2 and DQ8. Presentation occurs most often in the 40–60 years age-group, but potentially at any age. Symptoms attributable to the gut or to malabsorption may be mild, non-specific or absent; under one-third of patients have diarrhoea and almost half are overweight. Histological diagnosis no longer requires small intestine villous atrophy. The Marsh classification recognizes increased intraepithelial lymphocytes and crypt hyperplasia with intact villi as part of the gluten enteropathy spectrum, while some individuals have more subtle abnormalities identified only on electron microscopy. Serological testing for CD autoantibodies (to endomysium and tissue transglutaminase) has revolutionized diagnosis, shifting the process towards primary care. However, a substantial number of patients with CD are seronegative, particularly those without villous atrophy. The autoantibody to endomysium may be produced before histological change. The immune response to transglutaminase is crucial to the disease process. An exciting new development is the link between antibodies to organ-specific transglutaminases and clinical presentation; transglutaminases 2 (gut), 3 (skin) and 6 (nervous system). Negative testing for CD does not preclude its development later and HLA testing may allow ‘once and for all’ exclusion. In conclusion, an increasing proportion of patients with CD do not meet the ‘classic’ picture of malabsorption, positive serological testing and villous atrophy. Insisting on all these criteria for diagnosis will result in under diagnosis.

Download Full-text

HLA-DQ2 and/or-DQ9 is associated with coeliac disease specific autoantibodies to tissue transglutaminase in families with thyrold autoimmunity

Gastroenterology ◽

10.1016/s0016-5085(01)81952-1 ◽

2001 ◽

Vol 120 (5) ◽

pp. A393-A393

Author(s):

D SCHUPPAN ◽

W DIETERICH ◽

S HOFMANN ◽

M HUEFNER ◽

K USADEL ◽

...

Keyword(s):

Coeliac Disease ◽

Tissue Transglutaminase ◽

Disease Specific ◽

Hla Dq2

Download Full-text

Tissue transglutaminase and coeliac disease

Endoscopy ◽

10.1055/s-2005-922895 ◽

2006 ◽

Vol 37 (12) ◽

Author(s):

E Thornton ◽

M Lynskey ◽

J Donlon ◽

F Stevens

Keyword(s):

Coeliac Disease ◽

Tissue Transglutaminase

Download Full-text

O8 Is anti-tissue transglutaminase antibody titre greater than five times upper limit of normal suitable for no-biopsy pathway diagnosis of coeliac disease?

10.1136/flgastro-2021-bspghan.8 ◽

2021 ◽

Author(s):

Daniyal Raja ◽

Dharamveer Basude ◽

Siba Paul

Keyword(s):

Coeliac Disease ◽

Antibody Titre ◽

Tissue Transglutaminase ◽

Upper Limit

Download Full-text

Co-localization of tissue transglutaminase (tTG) and gliadin in duodenal mucosa of coeliac disease patients and healthy subjects

Digestive and Liver Disease ◽

10.1016/s1590-8658(00)80487-9 ◽

2000 ◽

Vol 32 ◽

pp. A77

Author(s):

R. Ciccocioppo ◽

S. D'Alò ◽

R. Parroni ◽

F. Biagi ◽

A. Di Sabatino ◽

...

Keyword(s):

Coeliac Disease ◽

Healthy Subjects ◽

Tissue Transglutaminase ◽

Duodenal Mucosa

Download Full-text

Is duodenal biopsy always necessary for the diagnosis of coeliac disease in adult patients with high anti-tissue transglutaminase (TTG) antibody titres?

Frontline Gastroenterology ◽

10.1136/flgastro-2020-101728 ◽

2021 ◽

pp. flgastro-2020-101728

Author(s):

Junaid Beig ◽

Kamran Rostami ◽

David T S Hayman ◽

Summer Hassan ◽

Stephen Gerred ◽

...

Keyword(s):

Coeliac Disease ◽

Linear Models ◽

Tissue Transglutaminase ◽

Signs And Symptoms ◽

Duodenal Biopsy ◽

Adult Patients ◽

Antibody Titres ◽

Red Flag ◽

The Relationship ◽

Duodenal Biopsies

ObjectiveAvoiding duodenal biopsy in adults for coeliac disease (CD) diagnosis is controversial. Some retrospective and prospective studies have shown that CD can be reliably diagnosed in adults with serology rather than duodenal biopsies. This study aimed to check the accuracy of a cut-off value of ≥10 upper limit of normal of anti-tissue transglutaminase antibody (anti-TTG IgA) titres for CD diagnosis in adult patients.MethodWe retrospectively analysed adult patients (≥16 years) who underwent gastroscopy from 2013 to 2018 for positive coeliac serology. The relationship between titres and disease was determined by using linear models, whereas sensitivity and specificity were assessed by receiver operator curve.ResultsWe analysed 144 newly anti-TTG antibody-positive adult patients with a median age of 48.5 years (IQR 32–62); among them, 86 (60%) patients had CD (Marsh III: n=68 and Marsh II and I: n=18) with a higher prevalence in females (n=59 (69%)) and Europeans (n=60 (70%)). Fifty (58%) patients with CD had colonoscopy and five (6%) had imaging; only six patients were diagnosed with additional conditions. An anti-TTG IgA titre cut-off value of 150 U/L was 100% specific for CD in our dataset, with 70% (95% CI: 60% to 88%) sensitivity for this patient group.ConclusionCoeliac serology using anti-TTG IgA with titres ≥10× normal value is an excellent predictor of CD, irrespective of age, gender and ethnicity. Duodenal biopsy may not be necessary in selected adult patients with CD, especially younger than 50 years of age without additional gastrointestinal red-flag signs and symptoms.

Download Full-text

Autoantibodies of patients with coeliac disease are insufficient to block tissue transglutaminase activity

Gut ◽

10.1136/gut.52.11.1562 ◽

2003 ◽

Vol 52 (11) ◽

pp. 1562-1566 ◽

Cited By ~ 40

Author(s):

W Dieterich

Keyword(s):

Coeliac Disease ◽

Tissue Transglutaminase ◽

Transglutaminase Activity

Download Full-text

Correlation between Clinical Symptoms of Coeliac Disease, Serum IgA Anti TTG and Biopsy in Pediatric Population of Northern India

Asian Journal of Clinical Pediatrics and Neonatology ◽

10.47009/ajcpn.2020.8.1.16 ◽

2020 ◽

Vol 8 (1) ◽

pp. 65-68

Author(s):

Sumit Jeena ◽

Jaswinder Kaur ◽

Nishant Wadhwa

Keyword(s):

Coeliac Disease ◽

Clinical Symptoms ◽

Tissue Transglutaminase ◽

Pediatric Population ◽

Clinical Manifestations ◽

North India ◽

P Value ◽

Serum Iga ◽

Significant Difference ◽

The Mean

Background: Celiac disease is basically an immune-mediated enteropathic condition produced by permanent sensitivity to gluten in genetically susceptible subjects. There is paucity of data in north India regarding clinical symptoms of coeliac disease, Serum IgA Anti TTG and Biopsy in pediatric population. The present study was conducted with the aim to determine the correlation between clinical symptoms of coeliac disease, Serum IgA Anti TTG and Biopsy in pediatric population of northern India.Materials and Methods: The present study was conducted in prospective including 73 pediatric patients at Department of Pediatric Gastroenterology, Institute of Child Health, Sir Gangaram Hospital, New Delhi, India. Esophagogastroduodenoendoscopy and serum anti Ig A tissue transglutaminase were performed. The characteristic scalloping of the folds were looked for in endoscopy followed by four duodenal biopsies performed from second part of duodenum and histological grading was performed as per modified marsh system. Patients with Serum IgA anti tTG>20 U/ml were confirmed to be at risk. Complete histological work up was done including hemoglobin, RBC indices and peripheral blood smear examination. The association of clinical manifestations with disease grade was also established with correlation coefficient. All the data thus obtained was arranged in a tabulated form and analyzed using SPSS software. Probability value of less than 0.05 was regarded as significant.Results: There were 4 males and 16 females with marsh grade 1 and 2 and mean age of 7.3±1.9 years. There were 5 males and 8 females with marsh grade 3a and mean age of 6.8±2.3 years. The mean weight of 18.11±3.89, height of 103.17±8.73 and BMI of 16.26±3.78 was observed amongst subjects with Marsh grade 1 and 2. The mean weight of 15.12±3.17, height of 99.28±9.19 and BMI of 15.02±3.20was observed amongst subjects with Marsh grade 3a. Diarrhoea was maximum amongst subjects with grade 3c and 4(70%) and minimum amongst Grade 1 and 2 (40%). There was a significant difference between the frequency of anemia amongst different grades as the p value was less than 0.05.Conclusion: The most common presenting signs and symptoms were diarrhea and abdominal pain. The study also concluded that the incidence of anemia increases with higher marsh grades.

Download Full-text