CoChat
Sign Up
Cited by 17Celiac Disease Research and ManagementEosinophilic EsophagitisWheat and Barley Genetics and Pathology

Optimization of serologic diagnosis of celiac disease in the pediatric setting

Open access
Bogaert, Laura, Cauchie, Mathieu, Van Hoovels, Lieve, Vermeersch, Pieter, Fierz, Walter, De Hertogh, Gert, Hoffman, Ilse, Bossuyt, Xavier·2020·Autoimmunity Reviews
DOI 10.1016/j.autrev.2020.102513
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND The clinical presentation of celiac disease (CD) varies between children. The objective of this study was to document the pre-test probability for CD based on symptoms and routine laboratory test and to evaluate the performance of two IgA anti-tissue transglutaminase (tTG) assays. We critically reviewed the concept of using multiples of the manufacturer's upper limit of normal (ULN), as proposed in the ESPGHAN guidelines (if IgA tTG is >10 times ULN, no biopsy is needed). METHODS The retrospective study included 91 children with newly diagnosed CD and 605 controls (<16 years). All underwent upper endoscopy with small bowel biopsies. Four laboratory parameters and 16 symptoms were registered. All patients were tested for IgA anti-tTG antibodies with assays from Inova Diagnostics and Thermo Fisher Scientific. RESULTS Some combinations of clinical symptoms and laboratory parameters had a high pre-test probability for CD, such as (combinations of) anorexia, failure to thrive, low ferritin level and elevated AST. The diagnostic performance of both IgA anti-tTG assays was excellent and comparable (no difference in ROC curve area under the curve). At a threshold that corresponds to a specificity of 100% (5 times ULN for Inova Diagnostics and 2 times ULN for Thermo Fisher), the sensitivity was 82% for both assays. At the 10 times ULN threshold, the sensitivity differed between the assays (77% vs. 57%), indicating that such threshold does not completely align interpretation across companies. CONCLUSIONS Our study showed that some combinations of symptoms and aberrant laboratory parameters had a high pre-test probability. The use of the ESPGHAN non-biopsy approach could reduce small bowel biopsies, but thresholds for IgA-tTG levels are not aligned across assays and should be based on predefined likelihood ratios or specificity.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.autrev.2020.102513

Cites

33 of 33 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Test result (or test result interval) specific likelihood ratios have already been applied for other autoantibodies (e.g. anti-MPO and anti-PR3 antibodies, anti-nuclear autoantibodies and anti-tissue transglutaminase antibodies).

    “This has already been applied for other autoantibodies (e.g. anti-MPO and anti-PR3 antibodies, anti-nuclear autoantibodies and anti-tissue transglutaminase antibodies) [85], [86], [87]”

    From Laboratory evaluation of anti-dsDNA antibodies. (2022) · cites this paper as [85]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. [21]21. J o u r n a l P r e -p r o o f Journal Pre-proof
  2. [32]32. J o u r n a l P r e -p r o o f Journal Pre-proof

Cited by

Sorted by citations

Related

Authors
Bogaert, L., Cauchie, M., Van Hoovels, L., Vermeersch, P., Fierz, W., De Hertogh, G., Hoffman, I., & Bossuyt, X.
Affiliations
  • Universitair Ziekenhuis Leuven (BE)
  • Europe Hospitals (BE)
Corresponding author
Bossuyt, Xavier
ORCID
Venue
Autoimmunity Reviews
Publisher
Elsevier BV
Published
2020-05
Volume
19
Issue
5
Pages
102513
ISSN
1568-9972 (ISSN-L)
DOI
10.1016/j.autrev.2020.102513
OpenAlex
W3011641169
Semantic Scholar
ef98ea54249fbc29214369bccd6ba4f3c1fc2d46
Cited by
17
References
33
Citations by year
2026: 2 · 2025: 1 · 2024: 1 · 2023: 5 · 2022: 1 · 2021: 2 · 2020: 4
FWCI
2.60
Type
journal article
Language
en
Open access
Licence
Locations
  • Autoimmunity Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • Lirias (KU Leuven) (submittedVersion, other-oa)
Funders
Scientific Research – Flanders
Topics
  • Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
  • Health Sciences › Medicine › Surgery › Eosinophilic Esophagitis
  • Life Sciences › Agricultural and Biological Sciences › Plant Science › Wheat and Barley Genetics and Pathology
Keywords
celiac disease, serological diagnosis, pretest probability, ESPGHAN guidelines, non-biopsy diagnosis, small bowel biopsy, sensitivity and specificity, pediatric celiac disease, failure to thrive, anorexia, ferritin, aspartate aminotransferase
MeSH terms
Adolescent, Autoantibodies, Biopsy, Celiac Disease, Child, Child, Preschool, Female, Humans, Immunoglobulin A, Infant, Infant, Newborn, Male, Transglutaminases, Retrospective Studies, Sensitivity and Specificity

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review