Diagnostic Yield of Isolated Deamidated Gliadin Peptide Antibody Elevation for Celiac Disease

Hoerter, Nicholas A.; Shannahan, Sarah; Suárez, J.M. Villa; Lewis, Suzanne K.; Green, Peter H. R.; Leffler, Daniel A.; Lebwohl, Benjamin

doi:10.1007/s10620-017-4474-5

Cited by 32 publications

(25 citation statements)

References 19 publications

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“…In conclusion, the study of Hoerter et al [10] adds to the growing evidence in favor of the use of DGP antibodies in the diagnosis of CD. The study shows that DGP antibodies can detect CD in patients recognized as seronegative for the most commonly used serologic strategy (IgA tTG plus total serum IgA).…”

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confidence: 69%

“…Although the study confirms that isolated total IgA deficiency is an important cause for SNCD, cases with a minor degree of enteropathy should also be considered. The results from Hoerter et al [10], in conjunction with those from previous studies, suggest that replacing total serum IgA measurement for DGP antibodies (mainly the IgG subtype), might have the advantage of detecting CD cases where the conventional strategy would exclude patients from further investigations. In the event of discordant serology (only IgA tTG or IgG DPG positive), intestinal biopsy assessment should be performed.…”

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confidence: 80%

“…In this issue of Digestive Diseases and Sciences, Hoerter et al [10] provide new evidence supporting the use of DGP antibodies as part of the diagnostic algorithm for CD. They retrospectively evaluated 84 patients from two well-recognized referral centers who had positive IgG and/or IgA DGP but negative IgA tTG antibodies, and a duodenal biopsy.…”

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confidence: 99%

“…Thus, the strategy used by Hoerter et al will likely increase diagnostic accuracy. Figure 1 depicts the conventional diagnostic strategy and the strategy proposed by Hoerter et al [10] in the diagnosis of CD. One drawback that needs to be elucidated in the future relates to the utilization of slightly different tests at the Boston (IgA or IgG DGP antibodies) and New York sites (blend combination of both DGP subtypes, single test).…”

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confidence: 99%

See 3 more Smart Citations

The CD That Pays Dividends: More Than 15 Years of Deamidated Gliadin Peptide Antibodies

Bai

Verdú

2017

Dig Dis Sci

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confidence: 69%

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confidence: 80%

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confidence: 99%

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confidence: 99%

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The CD That Pays Dividends: More Than 15 Years of Deamidated Gliadin Peptide Antibodies

Bai

Verdú

2017

Dig Dis Sci

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“…Furthermore, they underline the usefulness of DGP IgG assay in the serologic work-up of the CD diagnosis, as demonstrated also by another study which showed that performing serum tTG IgA plus DGP IgG had a higher diagnostic accuracy than tTG IgA assay alone. 35 On this basis, we must underline another limitation of our study as we did not perform serum DP IgG assay for all the patients referred to the Celiac Center. Consequently, other POCT-positive or POCT-negative/symptomatic patients could have been missed for CD diagnosis.…”

Section: Discussionmentioning

confidence: 96%

Diagnostic Yield of 2 Strategies for Adult Celiac Disease Identification in Primary Care

Scoglio

Trifirò²,

et al. 2019

Journal of Clinical Gastroenterology

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Goals:To compare the diagnostic yield and cost-consequences of 2 strategies, screening regardless of symptoms versus case finding (CF), using a point-of-care test (POCT), for the detection of celiac disease (CD) in primary care, to bridge the diagnostic gap of CD in adults. Materials and Methods:All subjects under 75 years of age who consecutively went to their general practitioners' offices were offered POCT for anti-transglutaminase immunoglobulin A antibodies. The POCT was performed on all subjects who agreed, and then a systematic search for symptoms or conditions associated with higher risk for CD was performed, immediately after the test but before knowing the test results. The 2 resulting groups were: (a) POCT positive and (b) symptomatic subject at CF. Subjects were defined as symptomatic at CF in the presence of 1 or more symptoms. All POCT-positive or symptomatic subjects at CF were referred to the CD Centers for confirmation of CD. Data on resource consumption were gathered from patients' charts. Cost of examinations, and diagnostic and laboratory tests were estimated with regional outpatient tariffs (Sicily), and a price of €2.5 was used for each POCT.Results: Of a total of 2197 subjects who agreed to participate in the study, 36 (1.6%) and 671 (30.5%) were POCT positive and symptomatic at CF, respectively. The yield from the screening and CF was 5 new celiac patients. The total cost and mean cost for each new CD case were €7497.35 and €1499.47 for the POCT screening strategy, and €9855.14 and €1971.03 for the CF strategy, respectively. Assuming consecutive use of both strategies, performing POCT only in symptomatic subjects at CF, the calculated yield would be 4 new diagnoses with a total cost of €2345.84 and a mean cost of €586.46 for each newly diagnosed patient. Only 1 patient was celiac despite a negative POCT. Conclusions:Testing symptomatic subjects at CF only by POCT seems the most cost-effective strategy to bridge the diagnostic gap of adult CD in primary care.

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Efficiency of Deamidated Gliadin Peptides for Screening Celiac Disease Autoimmunity

2018

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In Reply We fully appreciate Jichlinski's point that we have elided the issue of futile care at the end of life in our Viewpoint 1 on overuse in pediatrics. In adults, it is well known that a large percentage of Medicare expenditures occur in the final 6 months of life and that these expenditures may represent unwarranted variation in care. 2,3 While we know less about children, we do know that children with medical complexity account for a significantly larger percentage of medical expenditures than their numbers would predict. 4 Jichlinksi notes a persistent focus on the next medical intervention in children with progressive and fatal diseases rather than counseling around disease trajectory. We, too, have observed such patterns of care. However, we are also highly aware that our sample may be skewed by clinical experience focused on inpatient care. Families who do not choose the interventional approach exist and are effectively invisible to hospitalists and intensivists (our respective fields). They may also remain invisible to many pediatric residents unless they focus their training on outpatient palliative or complex care.An alternative perspective on unnecessary spending was provided by Mafi et al, 5 who suggest that low-cost, highvolume services may actually contribute the most to spending on unnecessary care in the United States. While the debate about where to focus any energy toward reducing unnecessary care is far from concluded and we do not propose to have the answers, we do agree with Jichlinksi that discussion around unnecessary care at the end of life should not be avoided in pediatrics.

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Diagnostic Yield of Isolated Deamidated Gliadin Peptide Antibody Elevation for Celiac Disease

Abstract: DGP antibody testing can identify cases of celiac disease in TTG-negative individuals, although the low positive predictive value suggests that the yield may be low.

Cited by 32 publications

References 19 publications

The CD That Pays Dividends: More Than 15 Years of Deamidated Gliadin Peptide Antibodies

The CD That Pays Dividends: More Than 15 Years of Deamidated Gliadin Peptide Antibodies

Diagnostic Yield of 2 Strategies for Adult Celiac Disease Identification in Primary Care

Efficiency of Deamidated Gliadin Peptides for Screening Celiac Disease Autoimmunity

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