This article is more than 5 years old. Information may no longer be current.
Algorithm differentiated celiac disease from non-celiac gluten sensitivity
Click Here to Manage Email Alerts
A diagnostic algorithm could help clinicians differentiate celiac disease from non-celiac gluten sensitivity, according to new research.
The algorithm first posits that patients with negative celiac serologies (IgA trans-glutaminase antibody [IgA tTG] or IgA/IgG deaminated gliadan peptide antibody [IgA/IgG DGP]) while on a normal diet are unlikely to have celiac disease (CD). Then, it assumes individuals with negative serology who lack clinical signs of malabsorption and CD risk factors are “highly likely” to have non-celiac gluten sensitivity (NCGS) and may not need further testing. Finally, those with equivocal serology should receive human leukocyte antigen (HLA) typing to determine if a biopsy is required.
Investigators retrospectively reviewed records from 238 patients, who presented with symptoms responsive to gluten restriction with no previous diagnosis or exclusion of CD. Researchers defined NCGS as symptoms responsive to a gluten-free diet (GFD) with negative celiac serology and duodenal biopsies, while on a diet containing gluten or negative HLA DQ2/DQ8 testing.
CD was diagnosed in 101 patients; 125 patients had NCGS, nine had non-celiac enteropathy, and three had indeterminate diagnoses.
“Currently, there is a large clinical practice discrepancy in approaching patients who self-start the GFD and have borderline or negative serology,” the investigators wrote. “Hence, in many circumstances, HLA testing and assessment of enteropathy risk factors are overlooked, and endoscopy is the default next step.”
CD patients presented with malabsorption symptoms in 67.3% of cases, compared with 24.8% in NCGS subjects (P<.0001). A family history of CD (P=.004), personal history of autoimmune diseases (P=.002) or nutrient deficiencies (P<.0001) were more likely in CD subjects.
The positive likelihood ratio for CD diagnosis of more than twice the upper limit of normal IgA tTG or IgA/IgG DGP with clinical response to GFD was 130% (CI: 18.5-918.3).
The positive likelihood ratio of the combination of gluten-response symptoms and negative IgA tTG or IgA/IgG DGP on a regular diet for NCGS was 9.6% (CI: 5.5-16.9). The positive likelihood ratio for NCGS increased to 80.9% when individuals with negative IgA tTG or IgA/IgG DGP also lacked symptoms of malabsorption and CD risk factors.
“On the basis of our model, endoscopy could have been avoided in 61.8% of subjects who had borderline or negative serology and underwent endoscopy for definitive diagnosis,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts