Celiac disease: diagnostic criteria in progress

Volta, Umberto; Villanacci, Vincenzo

doi:10.1038/cmi.2010.64

Cited by 107 publications

(133 citation statements)

References 92 publications

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“…It seems as preferable as combining two or more assays (especially DGP (IgA and IgG) þ tTG (IgA and IgG) or DGP (IgA and IgG)) as this shows both very high sensitivities and specificities (Table 3) compared to the single assays as concluded by others. 7,9,14,16 However, data derive from three studies only, and additional prospective studies as well as cost-benefit analyses are necessary before final recommendations can be made. In addition, more cohort studies should be conducted using DGP assays (both alone and combined with tTG) to confirm or refute the usefulness of these tests compared to other assays (tTG or EMA alone).…”

Section: Discussionmentioning

confidence: 99%

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Serological testing for celiac disease in adults

Schyum

Rumessen

2013

UEG Journal

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Background and aim: We present a systematic review on the performance of currently available methods for serological diagnosis of celiac disease (CD) and the role of human leukocyte antigen (HLA) typing. Objective: A literature survey was conducted using PubMed, MeSH database, Web of Science as well as manual searches. Results: Tissue transglutaminase antibodies (tTG) (IgA) (tested in nine studies) show sensitivities and specificities in the range of 0.76-0.968 and 0.909-0.98, and deamidated gliadin peptide (DGP) (IgA and IgG) (tested in eight studies) show sensitivities and specificities in the range of 0.69-0.984 and 0.903-1. Endomysial antibodies (EMA) (tested in five studies) show sensitivities and specificities in the range of 0.61-0.937 and 0.98-1, respectively. Combination assays (tested in three studies) using DGP þ tTG and DGP (IgA þ IgG) show sensitivities and specificities in the range of 0.87-1 and 0.8-1, respectively. HLA DQ2/DQ8 may be necessary for the development of CD-HLA DQ2 in particular. A possible close correlation may also exist between CD and HLA-G. Conclusion: DGP and tTG for serological testing for CD show equivalent diagnostic performance. More studies with, in particular, DGP alone and in combination with tTG are necessary before a firm recommendation can be made. HLA typing to exclude CD may still be controversial. It still seems premature to diagnose celiac disease in adults based on serology alone.

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Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12][13] The recently introduced deamidated gliadin peptide antibody (DGP) has shown promising performance as compared to EMA and tTG test results. [6][7][8][9][13][14][15] Data and experience concerning the usage of DGP are still preliminary, however.…”

Section: Introductionmentioning

confidence: 99%

Serological testing for celiac disease in adults

Schyum

Rumessen

2013

UEG Journal

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“…5 It must also be noted that diagnostic tools for gluten-induced disorders, such as celiac disease and wheat allergy, have progressively improved. 6,7 Gluten is the main protein complex of wheat and other cereals, including barley, rye and spelt. When gluten-containing flours are kneaded with water, gliadins and glutenins, the major components of gluten, provide viscosity and elasticity to the dough.…”

Section: Introductionmentioning

confidence: 99%

Non-celiac gluten sensitivity: questions still to be answered despite increasing awareness

et al. 2013

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Recently, the increasing number of patients worldwide who are sensitive to dietary gluten without evidence of celiac disease or wheat allergy has contributed to the identification of a new gluten-related syndrome defined as non-celiac gluten sensitivity. Our knowledge regarding this syndrome is still lacking, and many aspects of this syndrome remain unknown. Its pathogenesis is heterogeneous, with a recognized pivotal role for innate immunity; many other factors also contribute, including low-grade intestinal inflammation, increased intestinal barrier function and changes in the intestinal microbiota. Gluten and other wheat proteins, such as amylase trypsin inhibitors, are the primary triggers of this syndrome, but it has also been hypothesized that a diet rich in fermentable monosaccharides and polyols may elicit its functional gastrointestinal symptoms. The epidemiology of this condition is far from established; its prevalence in the general population is highly variable, ranging from 0.63% to 6%. From a clinical point of view, non-celiac gluten sensitivity is characterized by a wide array of gastrointestinal and extraintestinal symptoms that occur shortly after the ingestion of gluten and improve or disappear when gluten is withdrawn from the diet. These symptoms recur when gluten is reintroduced. Because diagnostic biomarkers have not yet been identified, a double-blind placebo-controlled gluten challenge is currently the diagnostic method with the highest accuracy. Future research is needed to generate more knowledge regarding non-celiac gluten sensitivity, a condition that has global acceptance but has only a few certainties and many unresolved issues.

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“…At the end of the pre-epidemic period diagnostic activity decreased (Figure 8). A new increase occurred in the mid 1980s coinciding with: the introduction of AGA, known for their high sensitivity (Volta 2011); the high number of infants presenting with typical clinical symptoms during the epidemic period; and an in- crease of the incidence rate. All these changes could have affected the diagnostic activity.…”

Section: Diagnostic Activitymentioning

confidence: 99%

“…At the end of the epidemic period, the diagnostic activity decreased in parallel with the incidence rate. In the end of 1990s, when the majority of the CD subjects were investigated with EMA, which have proved to be very specific (Volta 2011), the diagnostic activity increased again as well as the incidence rate of CD did. Since 1994 and onwards, both the diagnostic activity and the incidence rate demonstrated parallel changes (Figure 8).…”

Section: Diagnostic Activitymentioning

confidence: 99%

Demographics, clinical features and treatment of pediatric celiac disease

Tapsas¹

2015

Linköping University Medical Dissertations

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Celiac disease (CD) is a chronic small intestinal immune-mediated enteropathy triggered by ingestion of gluten-containing food in genetically predisposed subjects. The enteropathy is presented with a wide variety of clinical manifestations, which can occur even outside the gastrointestinal tract. In the majority of cases, the diagnosis of CD is based on a small intestinal biopsy showing mucosal alterations, i.e. intraepithelial lymphocytosis, crypt hyperplasia, and villous atrophy. The treatment, gluten-free diet (GFD), has recently been revised with the addition of gluten-free oats. Oats give a more diversified nutrition and increase the fibre content. The use of oats in CD is though still debated in some reports. A strict life-long adherence to the GFD can be problematic, especially for pediatric CD patients. Sweden reported of one of the highest observed CD prevalences worldwide, i.e. 3%, among 12-year-olds born during what has been described as "the Swedish celiac epidemic", 1984−1996.The aims of this thesis were to elucidate how pediatric CD has changed during a 41-year period in Sweden, i.e. 1973Sweden, i.e. −2013, in terms of clinical presentation, disease severity, incidence, and demographics. We also wanted to adress the compliance to the GFD, the use of oats in the GFD and the safety of oats inclusion in the diet by measuring urinary nitric oxide (NO) metabolites.Filed information provided data about 2856 pediatric patients investigated for suspected CD between 1973 and 2013; of which 1030 patients were diagnosed with CD. After the data analyses the mean age of CD patients was shown to increase after the celiac epidemic period.Currently, CD shows a less severe picture in terms of symptoms and intestinal pathology.Younger children suffer primarily from gastrointestinal symptoms and growth failure, whereas extra-intestinal manifestations are more often displayed among adolescents. viWe also reported an unusually high pediatric CD incidence rate and cumulative incidence, likely the highest reported worldwide. We hypothesised that the introduction of new antibody tests would affect the diagnostic activity and accuracy in performing small intestinal biopsies for CD investigation. However, the outcome of diagnostic activity and accuracy could not clearly be attributed to the use of antibody tests due to changes occurring in parallel during the 41-year study period, e.g. a different pattern of symptoms at presentation and improved knowledge of the disease among parents and health professionals.In a questionnaire-based study our patient group reported a high compliance to the GFD.Long duration of the GFD may, however, influence compliance negatively. Oats have been included to the GFD of our study population in most of the cases without reporting major complications related to their well-being.The urinary measurements of NO metabolites revealed two patient groups, one with high and one with low levels. The two populations did not differ regarding sex, age, compliance to the GFD or oats consumption. Fa...

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Celiac disease: diagnostic criteria in progress

Cited by 107 publications

References 92 publications

Serological testing for celiac disease in adults

Serological testing for celiac disease in adults

Non-celiac gluten sensitivity: questions still to be answered despite increasing awareness

Demographics, clinical features and treatment of pediatric celiac disease

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