The strategic use of biopsy in the diagnosis of coeliac disease in adults

Deane, Charlene; O'Connor, Eoghan; O'Donovan, Helen; McHale, Ciaran; Alvain, Aoife; Shannon, Eileen; Tormey, Vincent; Hynes, Seán O.; Byrnes, Valerie

doi:10.1016/j.dld.2023.07.021

Cited by 2 publications

(13 citation statements)

References 18 publications

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“…Thirteen studies were included in our meta-analysis, which were in complete accordance with the inclusion criteria [10][11][12][13][14][15][16][17][18][19][20][21][22]. Five of the selected studies were cross-sectional, and the rest were cohort studies, divided across both prospective and retrospective study types.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Studies from all over the world were included in our meta-analysis, including Hungary, India, Iran, Ireland, Italy, Romania, Sweden, and the United Kingdom. A total of 2505 patients were included in our study sample; all study characteristics are presented in detail in Table 2 [10][11][12][13][14][15][16][17][18][19][20][21][22]. It is significant to note that not only the units of measurement for anti-tTG antibody levels are different across most studies, but even the studies having similar measurement units have different cutoff values for anti-tTG levels.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Ten of the total 13 included studies in our meta-analysis were highquality studies, and three studies showed some risk of bias. Table 3 illustrates the results of the bias assessment of the five cross-sectional studies [10][11][12]20,22]. Among these studies, Akbari et al showed some risk of bias on the grounds of the small sample size and high rate of attrition [10].…”

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

“…The level of heterogeneity among studies reported for this outcome was high (I 2 = 80%). Figure 2 illustrates the result of meta-analysis across six studies that individuals with Marsh grade I and II histology have higher anti-tTG antibody levels in comparison to those with Marsh grade 0 (Z=7.85; p-value <0.00001) [10][11][12][17][18][19]. Marsh IIIa vs. Marsh 0…”

Section: Marsh I and Ii Vs Marshmentioning

confidence: 99%

“…A moderate level of heterogeneity among studies was reported for this outcome (I 2 = 66%). Figure 3 shows results suggesting that patients with histological damage of Marsh grade IIIa have higher anti-tTG antibody levels than those with Marsh grade 0 histology (Z=6.27; p-value <0.00001) [10][11][12][13][17][18][19][20].…”

Section: Marsh I and Ii Vs Marshmentioning

confidence: 99%

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The Correlation Between Serum Anti-tissue Transglutaminase (Anti-tTG) Antibody Levels and Histological Severity of Celiac Disease in Adolescents and Adults: A Meta-Analysis

Qureshi

2023

Cureus

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Celiac disease is an autoimmune disorder characterized by a broad spectrum of histological damage to the intestinal mucosa. Comprehension and understanding of the association between anti-tissue transglutaminase (anti-tTG) antibody levels and the histological severity of celiac disease are not well established, prompting the need for meta-analysis. This study aims to offer insights into the diagnostic abilities of anti-tTG antibody levels in determining the histological severity of celiac disease by providing quantitative evidence based on a diverse range of studies. An extensive search was conducted across four electronic research databases to identify primary research articles reporting serum anti-tTG antibody levels in correlation with different Marsh grades, signifying the histological severity of celiac disease. The software tool RevMan 5.4 (the Cochrane Collaboration, London, UK) was used to compile standardized mean differences (SMD) alongside their respective confidence intervals. A total of 13 studies were included in the meta-analysis, with a patient pool of 2505 patients. Marsh grade I and II were found to have higher anti-tTG antibody levels compared to those with grade 0 (SMD 1.50; 95% CI: 1.12, 1.87; p-value <0.00001). Antibody levels were higher in Marsh grade IIIa when compared to both grade 0 (SMD 0.97; 95% CI: 0.67, 1.28; p-value <0.00001) and grade ≤2 (SMD 0.61; 95% CI: 0.44, 0.79; p-value <0.00001). Patients with Marsh IIIb also reported greater anti-tTG levels compared to grade 0 (SMD 1.48; 95% CI: 0.99, 1.96; p-value <0.00001) and grade ≤2 (SMD 0.98; 95% CI: 0.79, 1.18; p-value <0.00001). Likewise, Marsh grade ≥IIIc reported high levels of anti-tTG antibodies in comparison with grade 0 (SMD 1.06; 95% CI: 0.72, 1.39; p-value <0.00001) and grade ≤2 (SMD 1.18; 95% CI: 1.02, 1.34; p-value <0.00001). Our meta-analysis revealed a consistent, robust correlation between anti-tTG antibody levels and the histological severity of celiac disease, with a clear trend of increasing antibody levels corresponding to the severity of mucosal damage. Large-scale primary research initiatives are needed to reach definitive conclusions.

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