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Limited utilization of serologic testing in patients undergoing duodenal biopsy for celiac disease.

Wiland HO, Henricks WH, Daly TM - BMC Gastroenterol (2013)

Bottom Line: The objective of this study was to determine the underlying causes for this low diagnostic yield.The majority of patients had no record of serologic testing prior to biopsy, and evidence of positive serology results was found in only 5% of patients.In patients where celiac serology testing was performed, the results were a good predictor of the likelihood of findings on biopsy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Robert J, Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Clinical Pathology, LL3-3, 9500 Euclid Avenue, 44195 Cleveland, OH, USA. dalyt@ccf.org.

ABSTRACT

Background: Clinical algorithms for the workup of celiac disease often recommend the use of serologic assays for initial screening, followed by duodenal biopsy for histologic confirmation. However, the majority of duodenal biopsies submitted to pathology for "rule out celiac" are negative. The objective of this study was to determine the underlying causes for this low diagnostic yield.

Methods: We performed a retrospective review of pathology reports from 1432 consecutive duodenal biopsies submitted for pathologic assessment to "rule out celiac" and correlated biopsy results with results for concurrent serologic testing for celiac autoantibodies.

Results: The majority of patients had no record of serologic testing prior to biopsy, and evidence of positive serology results was found in only 5% of patients. Most duodenal biopsies were submitted as part of a multi-site GI sampling strategy that included biopsies from other locations. In this context, serologic results correlated with the likelihood of significant duodenal and non-duodenal findings, and were also helpful in evaluating patients with indeterminate duodenal histology.

Conclusions: The presence of a positive screening test for celiac autoantibodies does not appear to be a major driver in the decision to submit duodenal biopsies for evaluation of celiac disease, which accounts for the low incidence of findings in these samples. In patients where celiac serology testing was performed, the results were a good predictor of the likelihood of findings on biopsy.

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Post-biopsy serologic results in patients biopsied for celiac disease. Patients are grouped into findings consistent with celiac disease, partial villous atrophy with intraepithelial lymphocytes, or no duodenal disease detected. Positive serologic findings were rarely seen in patients without characteristic histology. The two exceptions were both patients who had an indeterminate serology result for a single marker (one tTG IgA, one dGDN IgA).
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Figure 3: Post-biopsy serologic results in patients biopsied for celiac disease. Patients are grouped into findings consistent with celiac disease, partial villous atrophy with intraepithelial lymphocytes, or no duodenal disease detected. Positive serologic findings were rarely seen in patients without characteristic histology. The two exceptions were both patients who had an indeterminate serology result for a single marker (one tTG IgA, one dGDN IgA).

Mentions: Finally, we identified a subset of 65 patients where serology had been ordered after the biopsy was performed. The majority of these were patients with indeterminate (IVA-IEL) or negative histologic findings. In these patients, positive post-biopsy serologic findings were almost entirely limited to patients who had characteristic celiac disease findings on the biopsy (FigureĀ 3).


Limited utilization of serologic testing in patients undergoing duodenal biopsy for celiac disease.

Wiland HO, Henricks WH, Daly TM - BMC Gastroenterol (2013)

Post-biopsy serologic results in patients biopsied for celiac disease. Patients are grouped into findings consistent with celiac disease, partial villous atrophy with intraepithelial lymphocytes, or no duodenal disease detected. Positive serologic findings were rarely seen in patients without characteristic histology. The two exceptions were both patients who had an indeterminate serology result for a single marker (one tTG IgA, one dGDN IgA).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4225746&req=5

Figure 3: Post-biopsy serologic results in patients biopsied for celiac disease. Patients are grouped into findings consistent with celiac disease, partial villous atrophy with intraepithelial lymphocytes, or no duodenal disease detected. Positive serologic findings were rarely seen in patients without characteristic histology. The two exceptions were both patients who had an indeterminate serology result for a single marker (one tTG IgA, one dGDN IgA).
Mentions: Finally, we identified a subset of 65 patients where serology had been ordered after the biopsy was performed. The majority of these were patients with indeterminate (IVA-IEL) or negative histologic findings. In these patients, positive post-biopsy serologic findings were almost entirely limited to patients who had characteristic celiac disease findings on the biopsy (FigureĀ 3).

Bottom Line: The objective of this study was to determine the underlying causes for this low diagnostic yield.The majority of patients had no record of serologic testing prior to biopsy, and evidence of positive serology results was found in only 5% of patients.In patients where celiac serology testing was performed, the results were a good predictor of the likelihood of findings on biopsy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Robert J, Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Clinical Pathology, LL3-3, 9500 Euclid Avenue, 44195 Cleveland, OH, USA. dalyt@ccf.org.

ABSTRACT

Background: Clinical algorithms for the workup of celiac disease often recommend the use of serologic assays for initial screening, followed by duodenal biopsy for histologic confirmation. However, the majority of duodenal biopsies submitted to pathology for "rule out celiac" are negative. The objective of this study was to determine the underlying causes for this low diagnostic yield.

Methods: We performed a retrospective review of pathology reports from 1432 consecutive duodenal biopsies submitted for pathologic assessment to "rule out celiac" and correlated biopsy results with results for concurrent serologic testing for celiac autoantibodies.

Results: The majority of patients had no record of serologic testing prior to biopsy, and evidence of positive serology results was found in only 5% of patients. Most duodenal biopsies were submitted as part of a multi-site GI sampling strategy that included biopsies from other locations. In this context, serologic results correlated with the likelihood of significant duodenal and non-duodenal findings, and were also helpful in evaluating patients with indeterminate duodenal histology.

Conclusions: The presence of a positive screening test for celiac autoantibodies does not appear to be a major driver in the decision to submit duodenal biopsies for evaluation of celiac disease, which accounts for the low incidence of findings in these samples. In patients where celiac serology testing was performed, the results were a good predictor of the likelihood of findings on biopsy.

Show MeSH
Related in: MedlinePlus