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Celiac disease currently is diagnosed using both serologic testing (evaluating IgA anti–tissue transglutaminase [IgA-tTG]) and duodenal biopsy. However, might a nonbiopsy approach, currently used in children, be suitable for diagnosing celiac disease in adults (NEJM JW Gen Med Jun 15 2021 and Gut 2021; 70:876)?
Investigators undertook a meta-analysis of 18 studies that involved 12,000 patients with suspected celiac disease and examined the accuracy of IgA-tTG levels ≥10 times the upper limit of normal (10× ULN) for predicting a positive duodenal biopsy for this disorder. Sensitivity of serology was 51% (i.e., IgA-tTG level was ≥10× ULN in about half of biopsy-proven cases). Specificity was >99% (i.e., almost no false-positive serology result…