Introduction Current guidelines from the American College of Gastroenterology recommend confirming the diagnosis of celiac disease (CD) with duodenal biopsies. However, CD guidelines from the European Society of Paediatric Gastroenterology Hepatology and Nutrition provide criteria for diagnosing CD in children without the need for biopsy. We aimed at defining a level of anti‐tissue transglutaminase antibody (aTTG) for which histology results are consistently positive in adult patients. Methods We performed a retrospective study of patients with positive aTTG titers from 2010 to 2019 at the CIUSSS de l′Estrie CHUS. We calculated the sensitivity and specificity, as well as the optimal cutoff for aTTG‐IgA titers (expressed as upper limit of normal ULN) and the cutoff at which the positive predictive value (PPV) was 100%. Results We included 440 patients, of which 364 had a diagnosis of CD. A total of 66.8% of the 440 patients included were women with a mean age of 50.3 years. A total of 93.1% of the patients were symptomatic at the time of the study, with diarrhea being the most frequent presentation form (40.1%). To achieve a PPV of 100%, the cutoff point for the aTTG‐IgA titers was 8.76 ULN with a sensitivity of 50% and a specificity of 100%. Of note, none of the patients with potential CD developed complications during a 2‐year period after initial biopsy. Conclusions In this study, every adult patient with an aTTG‐IgA titer > 8.76 ULN had a confirmed diagnosis of CD, which means that the diagnosis of CD could be made without the need for biopsy.
Achtoutal et al. (Thu,) studied this question.