Does diagnosis by biopsy versus serology-only affect follow-up in celiac disease?

Serology-only diagnosis of celiac disease is increasing, but few recent studies have looked at the outcomes of patients undergoing this approach. The aim of this study was to evaluate difference in clinical follow-up and decline in tissue transglutaminase immunoglobulin A (TTG IgA) for patients receiving serology-only versus biopsy diagnosis of celiac disease.

Patients with a TTG IgA at or above 10 times upper limit of normal between October 1, 2020 and September 30, 2022 and were subsequently diagnosed with celiac disease with or without biopsy and had ongoing follow-up at Seattle Children's Hospital for 2 years after diagnosis were included. The patient's symptoms at diagnosis and follow-up visits, number of gastroenterology (GI) visits, timing of GI visits, number of dietician visits and timing of dietitian visits were documented. TTG IgA titers, human leukocyte antigen (HLA) antibody status, and esophagogastroduodenoscopy results were recorded. The data were analyzed using Student's t-test or the Wilcoxon rank-sum test as appropriate. Differences in categorical variables were assessed with chi-square.

Fifty-four patients were included. The mean age at diagnosis was 9.7 ± 4.3 years. Diagnosis was by biopsy in 32 (59%) patients and serology-only in 22 (41%) patients. The TTG IgA titers were similar at study baseline and decreased in both the biopsy and serology-only diagnostic groups. The p-value at all time points were not significant. The mean time to first dietitian visit, mean number of dietitian visits, and mean number of dietitian visits in the 24 months of follow-up was not significantly different between the groups.

Serology-only diagnosis resulted in a similar rate of clinical follow-up and TTG IgA reduction when compared to biopsy diagnosis.