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Non-biopsy Strategy for the Diagnosis of Celiac Disease in Adults: A Narrative Review
Herbert Wieser1, Carlo Soldaini2, Carolina Ciacci2
1Hamburg School of Food Science, Institute of Food Chemistry, University of Hamburg, Hamburg, Germany.
Insights
Celiac disease diagnosis can potentially omit duodenal biopsy in adults, mirroring pediatric guidelines. This review examines the evidence and implications of this non-biopsy strategy for celiac disease (CeD) detection.
Area of Science:
- Gastroenterology
- Immunology
- Clinical Diagnostics
Background:
- Celiac disease (CeD) diagnosis is complex, often requiring invasive procedures.
- Current guidelines from European and North American societies address CeD diagnosis and management.
- Pediatric guidelines allow avoiding duodenal biopsy in specific cases, a strategy also explored in adults.
Purpose of the Study:
- To review current evidence on the non-biopsy strategy for diagnosing celiac disease in adults.
- To analyze the implications, advantages, and disadvantages of omitting duodenal biopsy in adult CeD diagnosis.
Main Methods:
- This study is a narrative review of existing scientific literature.
- It synthesizes evidence regarding the non-biopsy approach for celiac disease diagnosis.
- The review focuses on studies applicable to adult patients.
Main Results:
- Pediatric guidelines support avoiding biopsy in symptomatic children with high IgA anti-transglutaminase levels.
- Similar studies in adults suggest the feasibility of a non-biopsy strategy.
- The application of this strategy in adults presents both benefits and drawbacks.
Conclusions:
- The omission of duodenal biopsy in celiac disease diagnosis is increasingly supported by evidence, particularly in adults.
- Further evaluation of the pros and cons is necessary for widespread clinical adoption.
- This review provides insights into the current landscape of non-biopsy celiac disease diagnosis in adults.
Abstract:
Celiac disease (CeD) diagnosis is a complicated process, requiring a multi-step procedure and a high level of clinical knowledge. Some scientific societies, mainly from Europe and North America, have proposed appropriate guidelines for the diagnosis and management of CeD. Since duodenal biopsy is particularly challenging for children, guidelines of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, presented in 2012 and updated in 2020, have made it possible to avoid the biopsy in symptomatic pediatric patients with high levels of IgA anti-transglutaminase. Several parallel, similar studies in adults support the non-biopsy strategy. However, several pros and cons exist in applying such a strategy. The present narrative review reports the current evidence and the implication of omitting biopsy in the diagnosis of CeD in adults.
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