Noninvasive approach for diagnosing coeliac disease feasible in low-risk adults

Coeliac disease may be safely diagnosed based on clinical features and endomysial antibody (EmA) testing in low-risk adult patients, according to a study.

The study included two cohorts. Cohort 1 consisted of 972 patients (mean age 42 years, 65.95 percent female) who underwent testing with both IgA EmA and upper endoscopy with duodenal biopsy while on a gluten-containing diet (GCD) for a suspicion of chronic enteropathies. Cohort 2 served as the validation cohort and included 214 patients (mean age 43 years, 67.76 female) who were suspected of coeliac disease or other chronic enteropathies.

In cohort 1, most patients underwent testing due to gastrointestinal symptoms such as diarrhoea (41.9 percent), weight loss (26.0 percent), abdominal pain (29.7 percent), and dyspepsia (27.8 percent) or other signs of malabsorption such as anaemia (19.3 percent). The remaining patients had a family history of coeliac disease (13.4 percent) or had associated autoimmune conditions (7.5 percent).

Coeliac disease was diagnosed in 35.4 percent, while noncoeliac enteropathies were found in 1.5 percent. Of those who received a coeliac disease diagnosis, 173 (50.3 percent) were <45 years old without alarm symptoms. None of the patients with coeliac disease had concomitant major organic disorders.

EmA had a diagnostic accuracy of 99.1 percent, with 97.4 percent sensitivity and 100 percent specificity and positive predictive value for detecting coeliac disease.

Noncoeliac enteropathies were found in 87 percent of patients aged ≥45 years old who had alarm symptoms and negative EmA. None of the patients without alarm symptoms had noncoeliac enteropathies.

The findings were confirmed in cohort 2.