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Pruebas diagnósticas para la enfermedad celíaca en pacientes con síntomas abdominales: una revisión sistemática
Daniëlle A W M van der Windt1, Petra Jellema, Chris J Mulder
1Arthritis Research UK National Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK. d.van.der.windt@cphc.keele.ac.uk
JAMA
|May 6, 2010
Resumen
El diagnóstico preciso de la enfermedad celíaca en adultos con síntomas abdominales se basa en pruebas de anticuerpos altamente sensibles y específicas. Se recomiendan los anticuerpos IgA anti-tejido transglutaminasa y IgA antiendomial para los entornos de atención primaria.
Área de la Ciencia:
- Gastroenterología y Gastroenterología.
- Inmunología Inmunología.
- Precisión en el diagnóstico.
Sus antecedentes:
- El diagnóstico y el tratamiento de la enfermedad celíaca a menudo implican una dieta libre de gluten, pero la presentación de los síntomas varía.
- Las pruebas diagnósticas innecesarias para la enfermedad celíaca deben minimizarse en la atención primaria debido a la variabilidad de los síntomas.
Objetivo del estudio:
- Evaluar el rendimiento diagnóstico de varias pruebas para la enfermedad celíaca en adultos con síntomas abdominales en la atención primaria.
- Resumir la evidencia sobre la precisión de las pruebas de diagnóstico para la enfermedad celíaca en poblaciones no seleccionadas.
Principales métodos:
- Revisión sistemática de la literatura de las bases de datos MEDLINE y EMBASE, complementada con búsquedas de referencias manuales.
- Inclusión de estudios de diagnóstico con diseños de casos y controles de cohorte o anidados, centrados en adultos con síntomas abdominales no agudos y baja prevalencia de enfermedad celíaca (≤15%).
- Evaluación independiente de la calidad y extracción de datos, con sensibilidad y especificidad agrupadas calculadas mediante análisis bivariado.
Principales resultados:
- Se revisaron dieciséis estudios (N=6085); el rendimiento de los síntomas abdominales varió ampliamente.
- La sensibilidad y especificidad combinadas para los anticuerpos antiendomiciales IgA fueron de 0,90 y 0,99, respectivamente.
- La sensibilidad combinada y la especificidad para los anticuerpos transglutaminasa anti-tejido IgA fueron de 0,89 y 0,98, respectivamente; los anticuerpos antigliadina IgA/IgG mostraron resultados variables.
Conclusiones:
- Los anticuerpos transglutaminasa anti-tejido IgA y los anticuerpos antiendomiciales IgA demuestran una alta sensibilidad y especificidad para el diagnóstico de la enfermedad celíaca en adultos con síntomas abdominales.
- Estas pruebas de anticuerpos son herramientas valiosas para el diagnóstico preciso de la enfermedad celíaca en la atención primaria y en poblaciones no seleccionadas.
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