Limited utilization of serologic testing in patients undergoing duodenal biopsy for celiac disease

BMC Gastroenterology

Thomas M Daly¹  Walter H Henricks¹  Homer O Wiland¹ 

[1] Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Clinical Pathology, LL3-3, 9500 Euclid Avenue, 44195 Cleveland, OH, USA

关键词: Utilization;    Duodenal biopsy;    Serology;    Celiac disease;   

Others  :  857497
DOI  :  10.1186/1471-230X-13-156

 received in 2013-02-27, accepted in 2013-11-04,  发布年份 2013

【 摘 要 】

Background

Clinical algorithms for the workup of celiac disease often recommend the use of serologic assays for initial screening, followed by duodenal biopsy for histologic confirmation. However, the majority of duodenal biopsies submitted to pathology for “rule out celiac” are negative. The objective of this study was to determine the underlying causes for this low diagnostic yield.

Methods

We performed a retrospective review of pathology reports from 1432 consecutive duodenal biopsies submitted for pathologic assessment to “rule out celiac” and correlated biopsy results with results for concurrent serologic testing for celiac autoantibodies.

Results

The majority of patients had no record of serologic testing prior to biopsy, and evidence of positive serology results was found in only 5% of patients. Most duodenal biopsies were submitted as part of a multi-site GI sampling strategy that included biopsies from other locations. In this context, serologic results correlated with the likelihood of significant duodenal and non-duodenal findings, and were also helpful in evaluating patients with indeterminate duodenal histology.

Conclusions

The presence of a positive screening test for celiac autoantibodies does not appear to be a major driver in the decision to submit duodenal biopsies for evaluation of celiac disease, which accounts for the low incidence of findings in these samples. In patients where celiac serology testing was performed, the results were a good predictor of the likelihood of findings on biopsy.

【 授权许可】

   
2013 Wiland et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Rewers M: Epidemiology of celiac disease: what are the prevalence, incidence, and progression of celiac disease? Gastroenterology 2005, 128(4 Suppl 1):S47-51.
• [2]Riddle MS, Murray JA, Porter CK: The incidence and risk of celiac disease in a healthy US adult population. Am J Gastroenterol 2012, 107(8):55-1248.
• [3]Reilly NR, Green PH: Epidemiology and clinical presentations of celiac disease. Semin Immunopathol 2012, 34(4):8-473.
• [4]Corrao G, Corazza GR, Bagnardi V, Brusco G, Ciacci C, Cottone M, Sategna Guidetti C, Usai P, Cesari P, Pelli MA, et al.: Mortality in patients with coeliac disease and their relatives: a cohort study. Lancet 2001, 358(9279):356-361.
• [5]Peters U, Askling J, Gridley G, Ekbom A, Linet M: Causes of death in patients with celiac disease in a population-based Swedish cohort. Arch Intern Med 2003, 163(13):1566-1572.
• [6]Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, Hoffenberg EJ, Horvath K, Murray JA, Pivor M, et al.: Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the north american society for pediatric gastroenterology, hepatology and nutrition. J Pediatr Gastroenterol Nutr 2005, 40(1):1-19.
• [7]Institute AGA: AGA institute medical position statement on the diagnosis and management of celiac disease. Gastroenterology 2006, 131(6):1977-1980.
• [8]Parakkal D, Du H, Semer R, Ehrenpreis ED, Guandalini S: Do gastroenterologists adhere to diagnostic and treatment guidelines for celiac disease? J Clin Gastroenterol 2012, 46(2):e12-20.
• [9]Evans KE, Sanders DS: What is the use of biopsy and antibodies in coeliac disease diagnosis? J Intern Med 2011, 269(6):572-581.
• [10]Katz KD, Rashtak S, Lahr BD, Melton LJ 3rd, Krause PK, Maggi K, Talley NJ, Murray JA: Screening for celiac disease in a North American population: sequential serology and gastrointestinal symptoms. Am J Gastroenterol 2011, 106(7):1333-1339.
• [11]Tack GJ, Verbeek WH, Schreurs MW, Mulder CJ: The spectrum of celiac disease: epidemiology, clinical aspects and treatment. Nat Rev Gastroenterol Hepatol 2010, 7(4):204-213.
• [12]Giersiepen K, Lelgemann M, Stuhldreher N, Ronfani L, Husby S, Koletzko S, Korponay-Szabo IR, Diagnosis EWGoCD: Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report. J Pediatr Gastroenterol Nutr 2012, 54(2):229-241.
• [13]Vermeersch P, Geboes K, Marien G, Hoffman I, Hiele M, Bossuyt X: Diagnostic performance of IgG anti-deamidated gliadin peptide antibody assays is comparable to IgA anti-tTG in celiac disease. Clin Chim Acta 2010, 411(13–14):931-935.
• [14]Chow MA, Lebwohl B, Reilly NR, Green PH: Immunoglobulin A deficiency in celiac disease. J Clin Gastroentero 2012, 46(10):4-850.
• [15]Rostom A, Dube C, Cranney A, Saloojee N, Sy R, Garritty C, Sampson M, Zhang L, Yazdi F, Mamaladze V, et al.: The diagnostic accuracy of serologic tests for celiac disease: a systematic review. Gastroenterology 2005, 128(4 Suppl 1):S38-46.
• [16]van der Windt DA, Jellema P, Mulder CJ, Kneepkens CM, van der Horst HE: Diagnostic testing for celiac disease among patients with abdominal symptoms: a systematic review. JAMA 2010, 303(17):1738-1746.
• [17]Collin P, Kaukinen K, Vogelsang H, Korponay-Szabo I, Sommer R, Schreier E, Volta U, Granito A, Veronesi L, Mascart F, et al.: Antiendomysial and antihuman recombinant tissue transglutaminase antibodies in the diagnosis of coeliac disease: a biopsy-proven European multicentre study. Eur J Gastroenterol Hepatol 2005, 17(1):85-91.
• [18]Reeves GE, Squance ML, Duggan AE, Murugasu RR, Wilson RJ, Wong RC, Gibson RA, Steele RH, Pollock WK: Diagnostic accuracy of coeliac serological tests: a prospective study. Eur J Gastroenterol Hepatol 2006, 18(5):493-501.
• [19]Burgin-Wolff A, Mauro B, Faruk H: Intestinal biopsy is not always required to diagnose celiac disease: a retrospective analysis of combined antibody tests. BMC Gastroenterol 2013, 13:19. BioMed Central Full Text
• [20]Aziz I, Evans KE, Hopper AD, Smillie DM, Sanders DS: A prospective study into the aetiology of lymphocytic duodenosis. Aliment Pharmacol Ther 2010, 32(11–12):1392-1397.
• [21]Brown I, Mino-Kenudson M, Deshpande V, Lauwers GY: Intraepithelial lymphocytosis in architecturally preserved proximal small intestinal mucosa: an increasing diagnostic problem with a wide differential diagnosis. Arch Pathol Lab Med 2006, 130(7):1020-1025.
• [22]Brown IS, Smith J, Rosty C: Gastrointestinal pathology in celiac disease: a case series of 150 consecutive newly diagnosed patients. Am J Clin Pathol 2012, 138(1):42-49.
• [23]Chetty R, Govender D: Lymphocytic and collagenous colitis: an overview of so-called microscopic colitis. Nat Rev Gastroenterol Hepatol 2012, 9(4):209-218.
• [24]Xiao Z, Dasari VM, Kirby DF, Bronner M, Plesec TP, Lashner BA: Collagenous sprue: a case report and literature review. Gastroenterol Hepatol (N Y) 2009, 5(6):418-424.
• [25]Goddard AF, McIntyre AS, Scott BB: Guidelines for the management of iron deficiency anaemia. British society of gastroenterology. Gut 2000, 46(Suppl 3–4):IV1-IV5.
• [26]Lebwohl B, Bhagat G, Markoff S, Lewis SK, Smukalla S, Neugut AI, Green PH: Prior endoscopy in patients with newly diagnosed celiac disease: a missed opportunity? Dig Dis Sci 2013, 58(5):1293-1298.
• [27]Hopper AD, Cross SS, Hurlstone DP, McAlindon ME, Lobo AJ, Hadjivassiliou M, Sloan ME, Dixon S, Sanders DS: Pre-endoscopy serological testing for coeliac disease: evaluation of a clinical decision tool. BMJ 2007, 334(7596):729.