Serologic diagnosis of celiac disease: May it be suitable for adults?  

作　　者：Giuseppe Losurdo Milena Di Leo Edoardo Santamato Monica Arena Maria Rendina Carmelo Luigiano Enzo Ierardi Alfredo Di Leo 

机构地区：[1]Section of Gastroenterology,Department of Emergency and Organ Transplantation,University of Bari,Bari 70124,Italy [2]Unit of Digestive Endoscopy,San Paolo Hospital,Milan 20090,Italy

出　　处：《World Journal of Gastroenterology》2021年第42期7233-7239,共7页世界胃肠病学杂志（英文版）

摘　　要：The diagnosis of coeliac disease(CD)in adult patients requires the simultaneous assessment of clinical presentation,serology,and typical histological picture of villous atrophy.However,several years ago,the European Society of Pediatric Gastroenterology,Hepatology,and Nutrition guidelines approved new criteria for the diagnosis in children:Biopsy could be avoided when antitransglutaminase antibody(TGA)values exceed the cut-off of×10 upper limit of normal(ULN)and anti-endomysium antibodies are positive,independently from value.This“no biopsy”approach is a decisive need for pediatric population,allowing to avoid stressful endoscopic procedures in children,if unnecessary.This approach relies on the correlation existing in children between TGA levels and assessment of mucosal atrophy according to Marsh’s classification.Several lines of evidence have shown that patients with villous atrophy have markedly elevated TGA levels.Therefore,we aim to perform a narrative review on the topic in adults.Despite that some studies confirmed that the×10 ULN threshold value has a very good diagnostic performance,several lines of evidence in adults suggest that TGA cut off should be different from that of pediatric population for reaching a good correlation with histological picture.In conclusion,the heterogeneity of study reports as well as some conditions,which may hamper the serological diagnosis of CD(such as seronegative CD and non-celiac villous atrophy)and are much more common in adults than in children,could represent a limitation for the“no biopsy”approach to CD diagnosis in patients outside the pediatric age.

关 键 词：Celiac disease Villous atrophy SEROLOGY BIOPSY Anti-transglutaminase antibody 

分 类 号：R574[医药卫生—消化系统]