The following is a summary of “Accuracy of the No-Biopsy Approach for the Diagnosis of Celiac Disease in Adults: A Systematic Review and Meta-Analysis,” published in the April 2024 issue of Gastroenterology by Shiha, et al.
While current international guidelines recommend duodenal biopsies for diagnosing celiac disease in adults, recent evidence proposed that elevated immunoglobulin A (IgA) anti-tissue transglutaminase (tTg) antibody levels exceeding 10 times the upper limit of normal (ULN) can reliably indicate celiac disease, potentially obviating the need for biopsy. A systematic review and meta-analysis sought to assess the accuracy of the no-biopsy approach in confirming celiac disease diagnosis among adults.
They systematically searched databases, including MEDLINE, EMBASE, Cochrane Library, and Web of Science from January 1998 to October 2023 for studies reporting sensitivity and specificity of IgA-tTG ≥10×ULN against duodenal biopsies (Marsh grade ≥2) in adults with suspected celiac disease. Summary estimates of sensitivity, specificity, and positive and negative likelihood ratios were calculated using a bivariate random effects model. The positive predictive value of the no-biopsy approach was determined across various pretest probabilities of celiac disease. The quality assessment methodology of the included studies was conducted using the QUADAS-2 tool. The study was registered with PROSPERO.
Eighteen studies involving 12,103 participants from 15 countries were included. The pooled prevalence of biopsy-proven celiac disease was 62% (95% CI, 40%–83%). The proportion of patients with IgA-tTG ≥10×ULN was 32% (95% CI, 24%–40%). The summary sensitivity of IgA-tTG ≥10×ULN was 51% (95% CI, 42%–60%), with specificity at 100% (95% CI, 98%–100%). The area under the summary receiver operating characteristic curve was 0.83 (95% CI, 0.77 – 0.89). The positive predictive value of the no-biopsy approach for identifying celiac disease patients ranged from 65% to 99% across celiac disease prevalence rates of 1% to 40%. Between-study heterogeneity was moderate (I2 =30.3%), and sensitivity analyses confirmed the robustness of the findings. Only one study exhibited a low risk of bias across all domains.
The findings of the meta-analysis supported the notion that selected adult patients with IgA-tTG ≥10×ULN and a moderate to high pretest probability of celiac disease may be diagnosed without invasive endoscopy and duodenal biopsy.
Reference: gastrojournal.org/article/S0016-5085(23)05688-3/fulltext
