How useful are the serologic tests for diagnosing celiac disease?

Ann Intern Med. 2007 Sep 4;147(5):294-302. Accuracy of serologic tests and HLA-DQ typing for diagnosing celiac disease. Hadithi M, et al.

Objective:  To define the performance of serologic testing and HLA-DQ typing prospectively.

Methods:  Prospective study of patients referred for small-bowel biopsy to diagnose celiac disease.   Compared serologic tests (AGA, TGA, and EMA) and HLA-DQ typing to reference standard of abnormal histologic findings and clinical resolution after gluten-free diet.  Serologic testing

Results:  Sixteen of 463 participants had celiac disease confirmed by pathological findings.

  • Positive result on both TGA and EMA testing had a sensitivity of 81% (CI, 54% to 95.9%), specificity of 99.3% (CI, 98.0% to 99.9%), and negative predictive value of 99.3% (CI, 98.0% to 99.9%).
  • Testing positive for either HLA-DQ type maximized sensitivity (100% [CI, 79% to 100%]) and negative predictive value (100% [CI, 98.6% to 100%]), whereas testing negative for both minimized the negative likelihood ratio (0.00 [CI, 0.00 to 0.40]) and posttest probability (0% [CI, 0% to 1.4%]).
  • The addition of HLA-DQ typing to TGA and EMA testing, and the addition of serologic testing to HLA-DQ typing, did not change test performance compared with either testing strategy alone.

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Clinical Informationist at EUH Branch Library
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