Introduction In adults, duodenal biopsy is mandatory for diagnosis of coeliac disease. This is usually preceded by serological tests for coeliac specific antibodies—anti-tissue transglutaminase (tTG) and endomysial antibodies (EMA). However, the recent guidelines produced by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)1 in 2010 recommend that histological assessment (duodenal biopsy) might be omitted in cases of anti-tTG more than 10 times the upper limit of normal which have been verified by endomysial positivity, a typical history for coeliac disease and HLA DQ2 or DQ8 positivity. Our aim was to analyse our adult population of patients with possible diagnosis of coeliac disease to ascertain the proportion of patients with anti-tTG levels more than 10 times the upper limit of normal.
Methods Retrospective collection of data were obtained from the electronic clinical patient database from 2008 to 2011 at York Hospital. Inclusion criteria were all patients with positive anti-tTG and available duodenal histology results while on normal diet. York Hospital uses the Orgentec Anti-tTG IgA kit.
Results 113 (70%) of the 161 patients were female. The median age was 49 years (Range 16–89 years). 52 patients (32%) had anti-tTG levels greater than 10 times the upper limit of normal (ie, with a value ≥100 u/ml). All 52 had positive EMA. 51/52 had typical symptoms (chronic diarrhoea, weight loss, fatigue, anaemia) while one patient had leg weakness and a positive family history for coeliac disease. All 52 patients had biopsies consistent with coeliac disease. One patient had HLA DQ2/DQ8 status checked, which was positive. The test was done due to equivocal IgA levels, weakly positive anti-tTG and Marsh I findings.
Conclusion In our local adult population of patients with known positive anti-tTG and duodenal histology, about a third of the patients had anti-tTG levels greater than 10 times the upper limit of normal. This group had biopsies consistent with coeliac disease. Therefore, the ESPGHAN diagnostic guideline recommending the omission of duodenal biopsies in patients with anti-tTG levels greater than 10 times the upper limit of normal may be applicable for a significant proportion of the adult population (other similar studies2 3 have found rates of 45–58%).
Competing interests None declared.
References 1. ESPGHAN Guidelines Diagnosis Coeliac Disease Children/Adolescents. 2010. http://www.celiac-disease-consortium.nl/attachments/080_Mearin%20ESPGHAN%20CD%20WG%20voor%20CDC%20november%202010.pdf
2. Mubarak A, Wolters VM, Gerritsen SA, et al. A biopsy is not always necessary to diagnose celiac disease. J Pediatr Gastroenterol Nutr 2011;52:554–7.
3. Hill PG, Holmes GK. Coeliac disease: a biopsy is not always necessary for diagnosis. Aliment Pharmaco Ther 2008; 27:572–7.
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