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Serological screening for coeliac disease in an adult general population: the HUNT study
Ina Lervåg Andersen1,2, Polina Lukina3, Ole T Dyrli3
1HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway ina.l.andersen@ntnu.no.
Insights
Serological screening for coeliac disease (CeD) using antitransglutaminase 2 (TG2) IgA assays is effective in the general adult population. While TG2 IgA shows high accuracy, TG2 IgG is not reliable for diagnosing CeD.
Area of Science:
- Gastroenterology
- Immunology
- Public Health
Background:
- A significant number of coeliac disease (CeD) cases remain undiagnosed in the general population.
- Effective screening methods are crucial for early detection and management of CeD.
Purpose of the Study:
- To evaluate the efficacy of serological screening for CeD in adults.
- To assess the diagnostic accuracy of antitransglutaminase 2 (TG2) IgA and IgG assays in a population-based study.
Main Methods:
- Utilized data from the Trøndelag Health Study (2017-2019) with 56,042 adult participants.
- Analyzed serum samples using dual TG2 IgA and IgG assays.
- Confirmed CeD diagnoses via endoscopy and duodenal biopsies (Marsh grade 3).
Main Results:
- The positive predictive value (PPV) of TG2 IgA for biopsy-confirmed CeD was 73.3%.
- Elevating the TG2 IgA threshold (≥10x ULN) increased PPV to 88.1%.
- TG2 IgG assays demonstrated low PPV (5.8%) and were insufficient for CeD diagnosis in TG2 IgA-negative individuals.
Conclusions:
- The TG2 IgA assay is a highly effective screening tool for CeD in the adult general population.
- TG2 IgG assays lack the diagnostic accuracy needed for reliable CeD identification.
- Improved screening strategies can aid in diagnosing previously undetected CeD cases.
Background:
A large proportion of individuals with coeliac disease (CeD) remain undiagnosed.
Objective:
The aim of this study was to assess serological screening for CeD in the adult general population.
Design:
The study was based on the fourth Trøndelag Health Study, a population-based study performed 2017-2019 in Nord-Trøndelag County, Norway, including 56 042 participants >20 years of age (54% participation rate). Serum samples were analysed with a dual antitransglutaminase 2 (TG2) IgA and IgG assay and seropositive participants were invited to endoscopy with duodenal biopsies. A CeD diagnosis was given if mucosal damage (Marsh grade 3) was found.
Results:
Histological evaluation of 657 seropositive participants confirmed CeD in 423. The positive predictive value (PPV) of a positive TG2 IgA was 73.3% (95% CI 69.7% to 77.0%) for biopsy-confirmed CeD. TG2 IgA ≥10 times the upper limit of normal (ULN), as used in the no-biopsy approach in children, increased the PPV to 88.1% (95% CI 84.8% to 91.4%). Primary TG2 IgG response was found in 87 participants, five of whom had biopsy-confirmed CeD. One of the participants with CeD primarily responding with TG2 IgG was IgA deficient. The PPV of a positive TG2 IgG was 5.8% (95% CI 1.9% to 12.9%) and of TG2 IgG ≥10× ULN was 9.5% (95% CI 1.2% to 30.4%) for biopsy-confirmed CeD in TG2 IgA-negative individuals.
Conclusion:
The TG2 IgA assay showed excellent abilities as a screening tool for CeD in the adult general population. However, the diagnostic accuracy of TG2 IgG was too poor for selectively identifying individuals with CeD.
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