Nonbiopsy Approach for Celiac Disease Is Accurate When Using Exact Duodenal Histomorphometry: Prospective Study in 2
Alina Popp1,2,3, Taina Arvola4,5, Juha Taavela1,2,6
1Centre for Child Health Research, Tampere University.
Insights
Accurate celiac disease diagnosis in children is possible using serology and quantitative histomorphometry. This method enhances the positive predictive value (PPV) of diagnostic criteria, confirming celiac disease with high accuracy.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Diagnostic Accuracy
Background:
- Revised European guidelines permit noninvasive celiac disease diagnosis in children.
- Suboptimal positive predictive value (PPV) of serology has been noted, potentially due to histopathology limitations.
- Quantitative histomorphometry offers a more precise reference standard for celiac disease diagnosis.
Purpose of the Study:
- To evaluate the accuracy of serology-based criteria for diagnosing celiac disease.
- To assess the utility of quantitative histomorphometry in improving diagnostic accuracy.
- To validate noninvasive diagnostic strategies in pediatric celiac disease.
Main Methods:
- Prospective enrollment of children with elevated tissue transglutaminase antibodies (TGA).
- Assessment of triple criteria: TGA ≥10× ULN, positive endomysium antibodies (EmA), and celiac disease-associated genetics.
- Comparison of initial grouped histopathology with centralized quantitative morphometry.
Main Results:
- Quantitative morphometry increased the PPV of celiac disease diagnosis to 100% in triple-positive children.
- The PPV for children with TGA <10× ULN improved from 73% to 85% with morphometry.
- Triple-positive children exhibited higher rates of anemia and elevated EmA and liver enzymes.
Conclusions:
- Serology-based criteria, especially when combined with quantitative histomorphometry, provide highly accurate celiac disease diagnosis in children.
- The nonbiopsy strategy demonstrates excellent PPV, further enhanced by standardized duodenal morphometry.
- Quantitative histomorphometry refines the accuracy of noninvasive celiac disease diagnosis.
Goals:
To test the accuracy of serology-based criteria for diagnosing celiac disease utilizing quantitative histomorphometry.
Background:
The revised European pediatric guidelines allow noninvasive celiac disease diagnosis for a subgroup of children. However, in some of the studies on this issue, the positive predictive value (PPV) of serology has remained suboptimal, possibly because of challenges of histopathology as the reference standard.
Study:
Prospectively enrolled children with transglutaminase 2 antibodies (TGA) above the upper limit of normal (ULN) underwent blood sampling and duodenal biopsy in Finland and Romania. Those with TGA ≥10× ULN, positive endomysium antibodies (EmA), and disease-associated genetics were considered to fulfill triple criteria for celiac disease. Initial histopathologic analysis was conducted using grouped classification, whereupon centralized morphometry was performed.
Results:
Altogether 88 (54%) children were triple positive. In local evaluation, 99% of triple-positive children and 73% of children with TGA <10× ULN had celiac disease. These figures increased to 100% and 85% after more precise morphometric analysis. Triple-positive children had more anemia and higher median EmA and liver enzyme values than those with TGA<10× ULN; the groups were comparable in other clinical features and laboratory parameters.
Conclusions:
When applied as recommended, the nonbiopsy strategy had already yielded excellent PPV regardless of the site of diagnosis or clinical presentation in the local analysis. PPV further increased to 100% with standardized duodenal morphometry.
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