New model predicts duodenal atrophy in adults with coeliac disease

A tissue transglutaminase (tTG) value of >5.5 upper the normal level (UNL) attained a specificity of 100 percent for the prediction of duodenal atrophy in patients with coeliac disease (CeD), reports a study. This cutoff value may be used to bypass the need for diagnostic endoscopy in adults suspected of CeD.

“In adults, the diagnosis of CeD relies on the presence of disease-specific antibodies and the confirmation of duodenal atrophy,” the authors said.

Consecutive adult patients who attended the Gastroenterology Department of Hospital de Clinicas between 2004 and 2023 were included in this retrospective observational study. Group 1 consisted of patients with positive tTG and Marsh 3 lesions, while group 2 included patients with normal duodenal biopsies, irrespective of tTG results.

The authors applied logistic regression models using different tTG cutoff values (dependent variable) to discriminate between “CeD” and “non-CeD.”

Overall, 211 patients met the eligibility criteria for group 1 and 267 for group 2. A tTG value of ≥2.5 had a specificity that exceeded 98 percent, with the highest specificity observed at 5.5 UNL. Model development was limited to individuals with complete data on all significant variables (n=290: 134 cases and 156 controls).

Female sex and folic acid deficiency significantly predicted CeD diagnosis. These factors increased sensitivity but not specificity at the 3 and 4 UNL.

“Although female sex and folic acid deficiency were independent predictors of CeD, their inclusion did not enhance the predictive performance at a lower tTG cutoffs,” the authors said.