Introduction Lymphocytic duodenosis (LD) is an early marker for coeliac disease (CD). However, the majority of cases are due to non-CD related conditions.
Aims To identify the predictors of CD when presented with LD.
Methods 215 LD patients had undergone prospective and systematic evaluation for CD and other recognised associations.
The gold-standard diagnosis of CD was based upon the presence of HLA-DQ2 and/or DQ8, persistence or progression of LD following a gluten challenge, symptomatic improvement on a gluten-free diet, and no alternate cause found.
Binary logistic regression models, adjusting for age and gender, were subsequently performed to compare presenting variables between CD and non-CD cases, and to determine their sensitivity, specificity, positive and negative predictive values (PPV and NPV).
Results CD was diagnosed in 47 cases (22%) and non-CD in 168 cases (78%). There was no statistical difference in demographics, clinical symptoms (i.e. diarrhoea, weight loss, abdominal pain), anaemia or haematinics between the CD and non-CD group.
Patients with CD, in comparison to non-CD, were significantly more likely to have a positive family history of CD (21.3% vs. 3.6%, OR 6.81; PPV 62.5%, NPV 81.4%, specificity 96.4%), positive HLA-DQ status (100% vs. 49.4%; PPV 36.2%, NPV 100%, specificity 50.6%), and presence of endomysial antibody [EMA] (49% vs. 0.6%, OR 159; PPV 96%, NPV 87%, specificity 99.4%); all p ≤ 0.001.
A normal tissue transglutaminase antibody (TTG) level was seen in 29.8% CD and 82.7% non-CD cases (OR 0.086, p < 0.001; PPV 9.1%). There was no difference in the prevalence of TTG levels 1–2 x upper limit of normal (ULN) between the groups (29.8% CD vs. 14.3% non-CD; PPV 38%). However, TTG levels between 3–20 x ULN were significantly more prevalent in the CD group (31.9% vs. 3%; PPV 66.6% >87.5%), whilst a TTG > 20 x ULN was exclusive to CD (8.5%, p < 0.001, PPV 100%).
Conclusion At the outset, only the presence of positive EMA or TTG > 20 x ULN are highly predictive and specific for CD. However, as they have limited sensitivities, most patients with LD require further work-up prior to diagnostic confirmation.
Disclosure of Interest None Declared.
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