The authors cite the various evidence guidelines as the basis of their summary that have been developed in recent years as well as literature search whose search strategy includes, among other things, all publications from the last ten years with the keywords "celiac disease" and "diagnosis" (). Unfortunately, our work, published in 2013, has not been considered, although it is based on many years of experience and tries to make reliable diagnosis with as few biopsies as possible ().
The best diagnostic test is the one with the lowest total of false positive and false negative diagnoses, therefore we suggest the following procedure:
- The first step: The simultaneous determination of IgA and IgG antibodies against deamidated gliadin peptides and IgA antibodies against “human tissue” transglutaminase (additionally total IgA). The majority of patients will either react positive to all three antigens tested or be negative on all three tests. In these two groups, biopsy is not necessary because the positive predictive value (ppv) is 99%, the positive likelihood ratio (lr +) 87, while the negative predictive value (npv) is 98% and the l negative likelihood -Ratio (lr−) is 0.01. If the IgA endomysial antibodies are also determined (4 tests), the result is even more meaningful (ppv 99%, lr + 86; npv 100%, lr− 0.00) ().
- Der The second step is the small intestine biopsy: It is only necessary for patients with contradicting antibody results, i.e. for patients who only react positively in one or two tests. With this “two-step procedure”, the number of patients to be biopsied can be reduced to fifth (,).
DOI: 10.3238 / arztebl.2014.0213b
Dr. phil A. Bürgin-Wolff
Prof. Dr. med. Faruk Hadziselimovic
Institute for Celiac Disease Diagnostics
Conflict of Interest span>
The authors declare that there is no conflict of interest.