Validation of no-biopsy pathway for the diagnosis of celiac disease in Asian adults: a multicenter retrospective study

Background and AimWhile European Society of Pediatric Gastroenterology Hepatology and Nutrition advocates a no-biopsy pathway for the diagnosis of celiac disease (CeD) in children if IgA anti-tissue transglutaminase antibody (anti-tTG ab) titer is >= 10-fold upper limit of normal (ULN) and have a positive IgA anti-endomysial antibody (EMA); the data for anti-tTG Ab titer-based diagnosis of CeD in adults is still emerging. We planned to validate if IgA anti-tTG Ab titer >= 10-fold predicts villous abnormalities of modified Marsh grade >= 2 in Asian adult patients with CeD.MethodsWe recruited 937 adult patients with positive anti-tTG Ab from two databases, including AIIMS Celiac Clinic and Indian National Biorepository. The diagnosis of definite CeD was made on the basis of a positive anti-tTG Ab and the presence of villous abnormalities of modified Marsh grade >= 2.ResultsOf 937 adult patients with positive anti-tTG Ab, 889 (91.2%) showed villous abnormalities of modified Marsh grade >= 2. Only 47.6% of 889 adults with CeD had anti- tTG Ab titers of >= 10-fold. The positive predictive value (PPV) and specificity of anti tTG Ab titer >= 10-fold for predicting modified Marsh grade >= 2 were 99.8% and 98%, respectively. At anti-tTG Ab titer >= 11-fold, specificity and PPV were 100% for predicting villous abnormalities of modified Marsh grade >= 2.ConclusionsApproximately 50% of adults with CeD may benefit from the no biopsy pathway, reducing the health burden and risks of gastroscopy/anesthesia. image