Accuracy of serologic tests and HLA-DQ typing for diagnosing celiac disease.
Ann Intern Med
; 147(5): 294-302, 2007 Sep 04.
Article
in En
| MEDLINE
| ID: mdl-17785484
ABSTRACT
BACKGROUND:
Estimates of the diagnostic performance of serologic testing and HLA-DQ typing for detecting celiac disease have mainly come from case-control studies.OBJECTIVE:
To define the performance of serologic testing and HLA-DQ typing prospectively.DESIGN:
Prospective cohort study.SETTING:
University hospital. PATIENTS Patients referred for small-bowel biopsy for the diagnosis of celiac disease.INTERVENTIONS:
Celiac serologic testing (antigliadin antibodies [AGA], antitransglutaminase antibodies [TGA], and antiendomysium antibodies [EMA]) and HLA-DQ typing. MEASUREMENTS Diagnostic performance of serologic testing and HLA-DQ typing compared with a reference standard of abnormal histologic findings and clinical resolution after a gluten-free diet.RESULTS:
Sixteen of 463 participants had celiac disease (prevalence, 3.46% [95% CI, 1.99% to 5.55%]). A 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.LIMITATION:
Few cases of celiac disease precluded meaningful comparisons of testing strategies.CONCLUSIONS:
In a patient population referred for symptoms and signs of celiac disease with a prevalence of celiac disease of 3.46%, TGA and EMA testing were the most sensitive serum antibody tests and a negative HLA-DQ type excluded the diagnosis. However, the addition of HLA-DQ typing to TGA and EMA testing, and the addition of serologic testing to HLA-DQ typing, provided the same measures of test performance as either testing strategy alone.
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Database:
MEDLINE
Main subject:
Immunologic Tests
/
HLA-DQ Antigens
/
Celiac Disease
Type of study:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Year:
2007
Type:
Article