Testing For Celiac Disease Research Articles

The Role of Serological Testing and HLA Genotyping in the Diagnosis of Celiac Disease in Slovak Cohort. Can Duodenal Biopsies be Omitted

Presented analysis focuses on usefulness of consecutive celiac disease antibodies testing anti-TG2 and EMA, and HLA-DQ2/DQ8 genotyping in symptomatic children and adolescents with suspected celiac disease refered to the latest ESPGHAN guidelines (2012), that permit confirmation of celiac disease without previous duodenal biopsy. A total of 258 children and adolescents (86 male and 172 girls), aged 2 to 18 years, were retrospectively examined performance of celiac disease testing according national guidelines from 2009 included duodenal sampling and the ESPGHAN nonbiopsy criteria in a pediatric population. In applying nonbiopsy criteria to our cohort, 33,3 % (86) of symptomatic children and adolescents with such high anti-TG2 titers and positive EMA could have been initially diagnosed without an intestinal biopsy. All of them presented with advanced intestinal atrophy Marsh 2-3. Part of the rational of the study was to determine sensitivity and specificity, positive and negative predictive values of the final laboratory tests and diagnostic accuracy of the combined tests for antibodies.

Are Australian Regional Hospitals Doing Enough for Coeliac Disease Testing in 2012-2013? A Pilot Study

Coeliac disease diagnosis requires adequate testing, and insufficient testing may increase complications. This pilot study determined the prevalence of appropriate testing for coeliac disease among eligible in-patients admitted in a regional Australian hospital. A retrospective review of all admissions were conducted between August 2012 and January 2013 in the medical, surgical and geriatric divisions for the patients diagnosed with haematinic-deficiency anaemia due to unspecified causes, protein-energy malnutrition due to unspecified causes and irritable Bowel Syndrome. Secondarily an extended review between February 2012 and February 2013 was also conducted to review all serology test requests for coeliac disease to identify the positive serology testing. We observed that, except for Iron Deficiency Anemia (IDA) and Irritable Bowel Syndrome (IBS), a very small proportion of unspecified anaemia and Protein Energy Malnutrition (PEM) patients were investigated (15.6% and 11%, respectively) for celiac disease. Invasive testing such as histopathology was requested only for about 52% of serology positive cases. Low diagnostic test requests for coeliac disease warrants the demand for availability of specialist gastroenterologist services and telemedicine support in regional Australia. Training for practicing doctors and continuing medical education around this may help adequate testing and diagnosis.

Abstract 8 Celiac Disease Testing in Type I Diabetics: A Quality Assurance Project

Abstract 8 Celiac Disease Testing in Type I Diabetics: A Quality Assurance Project

Self-Reported Non-Celiac Wheat Sensitivity in High School Students: Demographic and Clinical Characteristics.

Background: Non-Celiac Wheat Sensitivity (NCWS) has recently been included among the gluten-related disorders. As no biomarkers of this disease exist, its frequency has been estimated based on self-reported symptoms, but to date no data are available about self-reported NCWS in teenagers. Aim: To explore the prevalence of self-reported NCWS in a group of high school students and to study their demographic and clinical characteristics. Methods: The study was performed between April 2015 and January 2016 in two high schools of a coastal town in the south of Sicily (Italy). A total of 555 students (mean age 17 years, 191 male, 364 female) completed a modified validated questionnaire for self-reported NCWS. The subjects who self-reported NCWS were then compared with all the others. Results: Seven individuals (1.26%) had an established diagnosis of CD. The prevalence of self-reported NCWS was 12.2%, and 2.9% were following a gluten-free diet (GFD). Only 15 out of 68 (23%) NCWS self-reporters had consulted a doctor for this problem and only nine (14%) had undergone serological tests for celiac disease. The NCWS self-reporters very often had IBS symptoms (44%). Conclusions: Self-reported NCWS was found to be common in teenagers, with a frequency of 12.2%; the frequency of GFD use was 2.9%, which was much higher than the percentage of known CD in the same population (1.26%). A greater awareness of the possible implications on the part of the subjects involved, and a more thorough medical approach to the study of self-reported wheat-induced symptoms are required.

Testing for coeliac disease.

The symptoms of coeliac disease vary markedly from person to person. What is the gold standard for diagnosing coeliac disease?

Celiac disease in non-clinical populations of Japan.

Celiac disease is a chronic autoimmune enteropathy caused by gluten ingestion. While its prevalence in Western countries is reported to be as high as 1%, the prevalence has not been evaluated in a large-scale study of a Japanese population. The aim of our study was to clarify the possible presence of celiac disease in a Japanese non-clinical population as well as in patients showing symptoms suggestive of the disease. Serum samples were collected from 2008 non-clinical adults and 47 patients with chronic unexplained abdominal symptoms between April 2014 and June 2016. The anti-tissue transglutaminase (TTG) immunoglobulin A antibody titer was determined as a screening test for celiac disease in all subjects, and individuals with a value of >2U/mL subsequently underwent testing for the presence of serum endomysial IgA antibody (EMA) as confirmation. Those testing positive for EMA or with a high concentration (>10U/mL) of TTG were further investigated by histopathological examinations of duodenal mucosal biopsy specimens and HLA typing tests. Of the 2008 non-clinical adults from whom serum samples were collected, 161 tested positive for TTG, and all tested negative for EMA. Four subjects who had a high TTG titer were invited to undergo confirmatory testing, and the histopathological results confirmed the presence of celiac disease in only a single case (0.05%). Of the 47 symptomatic patients, one (2.1%) was found to have a high TTG titer and was diagnosed with celiac disease based on duodenal histopathological findings. The presence of celiac disease in a non-clinical Japanese population was low at 0.05% and was rarely found in patients with unexplained chronic abdominal symptoms.

417 - Celiac Disease Testing in Type I Diabetics: A Quality Assurance Project

417 - Celiac Disease Testing in Type I Diabetics: A Quality Assurance Project

Sa1021 - Laboratory Testing for Celiac Disease at the University of Vermont Medical Center: Testing Practices, Utilization, and Evidence for a Standardized Approach to Diagnosis

Sa1021 - Laboratory Testing for Celiac Disease at the University of Vermont Medical Center: Testing Practices, Utilization, and Evidence for a Standardized Approach to Diagnosis

Diagnostic Yield of Isolated Deamidated Gliadin Peptide Antibody Elevation for Celiac Disease.

Serologic testing for celiac disease includes tissue transglutaminase and endomysial antibodies. In addition to these tools, assays for deamidated gliadin peptide antibodies have been shown to have sensitivity and specificity that are comparable to tissue transglutaminase testing, and are increasingly being used for celiac disease testing. The goal of this study is to evaluate the utility of deamidated gliadin peptide (DGP) testing in the setting of a negative tissue transglutaminase (TTG) IgA test. We reviewed the records of all patients seen at two U.S. celiac disease referral centers and identified those who had an elevated DGP IgA and/or IgG in the setting of a negative TTG IgA. Of these patients, those who underwent duodenal biopsy while on a gluten-containing diet were included. Patients with prior biopsy-proven celiac disease or prior TTG IgA positivity were excluded. The results of the biopsy were used as the gold standard for celiac disease diagnosis, and patients with villous atrophy (Marsh class 3) on duodenal biopsy were considered to have celiac disease. Between the two institutions, 84 patients were identified with negative TTG IgA and positive DGP IgA or IgG who also had duodenal biopsies performed while maintaining a gluten-containing diet. Of these patients, 13 patients (15.5%; 95% CI 8.5-25.0%) were found to have celiac disease on duodenal biopsy. DGP antibody testing can identify cases of celiac disease in TTG-negative individuals, although the low positive predictive value suggests that the yield may be low.

Point of care testing for paediatric coeliac disease in the new ESPGHAN era.

One of the challenges in coeliac disease is the significant under-diagnosis despite the increasing prevalence and international guidelines for serological screening in appropriate patient cohorts. Several point-of-care tests for coeliac disease have been developed over the past decade with the aim of improving case detection using rapid and convenient testing. Most point-of-care tests, such as Biocard, detect anti-tissue transglutaminase (tTG) IgA antibodies, whereas Simtomax uniquely detects anti-deamidated gliadin peptide (DGP) IgA/IgG antibodies. A recent head-to-head trial in adults comparing two tTG-based point-of-care tests (Biocard and Celiac Quick Test) and Simtomax found that Simtomax was superior to Biocard and Celiac Quick Test, with sensitivities of 92.7%, 72.2% and 77.8%, respectively.

Variability of anti-human transglutaminase testing in celiac disease across Mediterranean countries.

AIMTo verify the precision and accuracy of transglutaminase antibodies (TGA) assays across Mediterranean countries.METHODSThis study involved 8 referral centres for celiac disease (CD) in 7 Mediterranean countries. A central laboratory prepared 8 kits of 7 blinded and randomized serum samples, with a titrated amount of Human TGA IgA. Each sample was analysed three times on three different days, with each centre running a total of 21 tests. The results were included in a blindly coded report form, which was sent to the coordinator centre. The coordinator estimated the mean coefficient of Variation (CoVar = σ/μ), the mean accuracy (Accur = Vobserved - Vreal) and the mean percent variation (Var% = [(Vobserved - Vreal)/Vreal] × 100).RESULTSThe analysis showed that 79.17% of the mean variation fell between -25% and +25% of the expected value, with the accuracy and precision progressively increasing with higher titres of TGA. From values 1.25 times greater than the normal cut-off, the measurements were highly reliable.CONCLUSIONTGA estimation is a crucial step for the diagnosis of CD; given its accuracy and precision, clinicians could be confident in establishing a diagnosis.

Vedolizumab: A Peek into the Future of Autoimmune Enteropathy

Autoimmune enteropathy (AIE) is characterized by protracted diarrhea and malnutrition. Vedolizumab; a humanized monoclonal antibody that inhibits adhesion and migration of leukocytes into the gastrointestinal tract and has never been used to treat autoimmune enteropathy in the past, but in this case has given us glimpse of a new modality that can be further established with research. We present to you a case of a 72-year-old Caucasian male with history of bilateral inguinal hernia repair. He was admitted to an outside hospital with diarrhea and weight loss for 6 months, without a recognizable etiology. He reported having 10-15 watery bowel movements daily along with small amount of blood and mucus associated with diffuse abdominal pain. Physical examination showed cachectic appearing male with normal vital signs, hyperactive bowel sounds and mild diffuse tenderness on deep palpation. Pertinent laboratory work showed: hemoglobin of 10 g/dl; ESR 19 mm/hr; albumin 2.7 g/dl and antinuclear antibodies with a titer of 1:320. Comprehensive stool studies were negative for enteric pathogens. Serological tests for celiac disease were also non contributory. Esophagogastroduodenoscopy demonstrated normal stomach, duodenum and proximal jejunum with unremarkable biopsies. Evidence of ileitis and right sided colitis was found on colonoscopy. Due to concerns for Crohn's disease he was initially started on mesalamine, azathioprine, prednisone to which his symptoms didn't respond. Later Infliximab was added only to worsen his condition. He presented to our hospital for further evaluation after significant weight loss. Repeat colonoscopy showed severe inflammation of terminal ileum, ascending and transverse colon. Random biopsies from terminal ileum and colon suggested changes consistent with autoimmune enteropathy or graft versus host disease. It was decided to switch infliximab to Vedolizumab in hope to treat his refractory symptoms. To our pleasant surprise one month on treatment he started showing signs of improvement. In three months on Vedolizumab, his stool frequency reduced to one bowel movement daily with documented weight gain with overall clinical improvement. Autoimmune enteropathy is exceedingly rare, treatment options are still being explored. Vedolizumab, which was used to treat this disorder for the first time has shown a very promising result. Further research with this drug would give us more insight into this immune milieu.

Low Rates of Celiac Disease Testing in Outpatients with Iron Deficiency Anemia

Low Rates of Celiac Disease Testing in Outpatients with Iron Deficiency Anemia

Early recognition of coeliac disease through community pharmacies: a proof of concept study.

Setting Fifteen community pharmacies in the UK. Objective Proof of concept study to test the use of community pharmacies for active case finding of patients with coeliac disease. Methods Customers accessing over-the counter and prescription medicines indicated in the treatment of possible symptoms of coeliac disease over a 6 month period were offered a free point of care test. All patients were given advice regarding the test results and those who tested positive were advised to make an appointment with their general practitioner. Patients and pharmacists involved in service provision were asked to complete a satisfaction survey. Pharmacists were additionally invited to undertake interviews to better understand their views on the service. Main outcome measures Feasibility of service, acceptability to stakeholders and proportion testing positive for coeliac disease. Results Of the 551 individuals tested, 52 (9.4 %) tested positive. 277 (50.3 %) were tested for accessing irritable bowel syndrome treatment, 142 (25.8 %) due to presenting for diarrhoea. The proportion of patients testing positive with different symptoms or for different treatments were similar. Of 43 customers who returned the satisfaction survey, all would recommend the service to others, believing the community pharmacy to be a suitable location. Community pharmacists believed that it enabled them to improve relationships with their customers and that medical practices were receptive to the service. Conclusion This proof of concept study has shown that community pharmacies using a point of care test can effectively recognise and refer patients for confirmatory coeliac disease testing with high levels of customer and service provider satisfaction.

Primate liver tissue as an alternative substrate for endomysium antibody immunofluorescence testing in diagnostics of paediatric coeliac disease

BackgroundImmunofluorescence assays of antibodies against endomysium (EmA) on primate oesophagus sections represent the gold standard in serological testing for coeliac disease (CD). As alternative immunofluorescence technique, staining of primate liver tissue is in use. We compared performance and predictive power of IgA- and IgG-EmA on primate oesophagus and primate liver sections. MethodsSera of 298 paediatric biopsy-proven CD patients under gluten-containing diet and 574 disease controls were investigated. Samples were collected between 2004 and 2013 in six children's hospitals. The antibodies were assayed blinded to diagnoses and histological data. Sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) were calculated for different assays. Results(Oesophagus vs liver): For IgA-EmA, sensitivity (0.953 vs 0.956) and specificity (0.981 vs 0.972) as well as PPV (0.963 vs 0.947) and NPV (0.976 vs 0.979) were comparable on both tissues. IgG-EmA on liver showed significantly higher sensitivity (0.520 vs 0.631; p=0.006) but significantly lower specificity (0.995 vs 0.963; p=0.002) and PPV (0.981 vs 0.899; p=0.0002) than on oesophagus. NPV on liver was higher than NPV on oesophagus, however, the difference was not statistically significant (0.799 vs 0.834; p=0.099). ConclusionPrimate liver can be used as alternative, equally well functioning substrate for IgA-EmA testing.

PTU-128 Prevalence and Management of Irritable Bowel Syndrome Seen in Colorectal Surgery and Gastroenterology Clinics

Introduction Irritable bowel syndrome (IBS) in the UK accounts for a large proportion of patients seen in secondary care. Pathways to the diagnosis of IBS are not standardised, and patients are often reviewed outside a luminal Gastroenterology service. We examined the burden of IBS in both Colorectal Surgery and Gastroenterology clinics. Methods All patients seen with IBS in either Gastroenterology (GE) or Colorectal Surgery (CS) clinics over a 1 month period January to February 2014 at Leeds Teaching Hospitals NHS Trust were identified. The following data were retrospectively recorded: age/sex of the patient, investigations prior to diagnosis, number of visits to that speciality clinic, number and type of medications prescribed, and final placement of the patient. We compared management of patients in both settings using a Chi-squared test. Results There were a total of 76 patients with IBS seen in CS clinics (mean age 49.6 years, 39 (51.3%) female) and 57 patients in GE clinics (mean age 39.1 years, 39 (68.4%) female). The number and type of investigations requested prior to diagnosis are detailed in Table 1. In CS clinics, colonic imaging (colonoscopy, sigmoidoscopy or barium enema) was requested in 70 (92.1%) patients, compared with 39 (68.4%) patients in GE clinics (P = 0.001). Cross-sectional imaging was utilised in 36 (47.4%) patients in CS clinics, compared with 19 (33.3%) patients in GE clinics (P = 0.15). Serological testing for coeliac disease was not performed in 22 (29.9%) patients in CS clinics, and 5 (8.8%) patients in GE clinics (P = 0.008). For the CS clinic patients the mean number of visits was 2.7 (range 1–14) with 22 (28.95%) patients offered prescribed therapy. In the GE clinic patients the mean number of visits was 2.5 (range 1–5), with 43 (75.4%) patients offered prescribed therapy (P Conclusion These data highlight the need for a more consistent referral process, and a more specialised approach to the management of this patient group. This should be based on current guidelines for the management of IBS using evidence-based treatments and with easy access to dietetic, psychological, and specialist nurse support. Disclosure of Interest None Declared

PTU-125 Laboratory Investigations for Patients Meeting Diagnostic Criteria for Irritable Bowel Syndrome: Are We Meeting the Standards?

Introduction Alongside a thorough clinical assessment NICE clinical guideline 61 recommends that patients meeting diagnostic criteria for irritable bowel syndrome (IBS), as defined by the Rome III criteria, should undergo laboratory testing for inflammation (C-reactive peptide (CRP) and plasma viscosity (PV) or erythrocyte sedimentation rate (ESR)), full blood count (FBC) and antibody testing for coeliac disease to exclude non-organic pathology.1 Faecal calprotectin is a reliable and cost effective adjuvant test to help differentiate between functional and inflammatory bowel disease (IBD).2,3 Our aim was to assess local adherence to NICE guidelines on investigating patients who meet diagnostic criteria for IBS. Methods As part of a wider study into the use of faecal calprotectin as a diagnostic tool within Gloucestershire Hospitals NHS Foundation Trust, we interrogated clinic letters, endoscopy reports and pathology results for patients in whom a negative ( Results Of the 148 patients (age range: 16–81, median age: 35; 72% female) who satisfied inclusion criteria, 63.5% (n = 94) had not undergone at least one of the recommended laboratory tests around the time of faecal calprotectin measurement. PV/ESR had not been checked in a majority (54.1%). Notably, 7.4% of patients had never had coeliac serology checked, 72.7% of whom presented with a change in bowel habit. Conclusion Although clear guidance exists for the investigation of patients meeting diagnostic criteria for IBS and use of faecal calprotectin as a diagnostic tool, insufficient essential accessory investigations are being completed. This risks conditions such as IBD, gastrointestinal cancer and coeliac disease being misdiagnosed as IBS with significant implications for delays in management and ongoing avoidable morbidity. We are reviewing measures to improve local adherence to NICE guidance, and call on other Trusts nationally to reflect on their own practice. References 1 Irritable bowel syndrome in adults: diagnosis and management. NICE guidelines [CG61]. Published: February 2008. 2 Konikoff MR, Denson LA. Role of faecal calprotectin as a biomarker of intestinal inflammation in inflammatory bowel disease. Inflammatory Bowel Diseases 2006;12(6):524–34. 3 Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel. NICE diagnostics guidance [DG11]. Published: October 2013. Disclosure of Interest None Declared

Unusual Presentation of Celiac Disease in a Toddler from a Pediatric Surgery Unit

Celiac disease is an intestinal autoimmune disease induced by the ingestion of gluten proteins (wheat, rye, barley) in genetically susceptible individuals. Celiac disease can present with gastrointestinal or extraintestinal manifestations (malabsorbtion, diarrhea, constipation, liver, skin or bones disorders). We present the case of a 14-months-old girl admitted for altered general condition and symptoms of intestinal occlusion (severe abdominal pain, absence of feces, abdominal distension), with associated severe malnutrition. History revealed chronic diarrhea and a lactose intolerance diagnosed 3 months prior to admission. The biochemical and imaging investigations excluded any acute surgical pathology. The serological tests showed high values of anti-tissue transglutaminase antibodies. The intestinal biopsy confirmed celiac disease. In children with suspicion of intestinal obstruction associated with a history of diarrhea or constipation and failure to thrive, testing for celiac disease should be considered.

Evaluation of a DGP Point-of-care Test for Celiac Disease in a Pediatric Population

Celiac disease (CD) is a largely undiagnosed immune-mediated enteropathy. A point-of-care test (POCT) could represent a rapid and cost-effective tool on ruling out CD. The objective of this study is to evaluate retrospectively the performance of a POCT based on detection of IgA and IgG antibodies against deamidated gliadins peptides (DGP). The study was performed on 53 children presenting clinical suspicions of CD, all being investigated by intestinal biopsy and standard serology. The performance of POCT was compared to the diagnostic result obtained from the gold standard of histology and serology. 10 children were diagnosed as CD positive by the POCT. Among the 43 children identified as CD negatives, 37 were correctly identified by POCT and 6 were considered as false positives. No false negative results were observed. The POCT yields a sensitivity and a negative predictive value (NPV) of 100%, and a negative likelihood ratio (LR-) of 0 in this selected pediatric population. The high NPV and low LR- ratio indicate that this POCT could be an useful and discriminative tool for excluding CD. This study and the results published so far are promising but need to be confirmed in larger cohort.

Tu1392 Accuracy of Tissue Transglutaminase (tTG) Testing for Celiac Disease in a Large Community Based Population

Tu1392 Accuracy of Tissue Transglutaminase (tTG) Testing for Celiac Disease in a Large Community Based Population