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Cellular & Molecular Immunology (2011) 8, 146149 2011 CSI and USTC. All rights reserved 1672-7681/11 $32.00 http://www.nature.com/cmi
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RESEARCH ARTICLE
A new algorithm for the diagnosis of celiac disease
Orit Rozenberg1,4, Aaron Lerner2,3,4, Avi Pacht2, Maya Grinberg1, Dina Reginashvili1, Clara Henig1
and Mira Barak1,4
Celiac disease (CD) affects at least 1% of the Western population but remains largely unrecognized. In our laboratory, we utilize a novel algorithm to diagnose pediatric CD that offers both high sensitivity and high specificity for diagnosis in an outpatient setting. The aim of the present study was to challenge this algorithm and to test its performance in children and adults suspected of having CD. Using a three-assay algorithm, screening with the most sensitive tissue transglutaminase (tTG) complexed with deamidated gliadin peptide neoepitope immunoglobulin A (IgA)1IgG assay and confirming with the two specific tTG IgA and tTG IgA1IgG assays, we examined the serological results from 112 children aged 017 years old and 60 adults in comparison to their respective biopsy results. The algorithm performance was calculated by statistical analysis. The use of the new algorithm enabled us to diagnose CD with 98% sensitivity, 93% specificity and 95% accuracy in the pediatric group and 94% sensitivity, 92% specificity and 93% accuracy in the total population studied. The false-negative cases in the adult group were attributed to previous adherence to a gluten-free diet, and the single false-negative result in a young child became a true positive after 6 months. We have also monitored three celiac patients before and after diagnosis and found that the algorithm may be suitable for disease monitoring. The newly proposed three-assay algorithm for celiac detection is very reliable in both children and adults. Due to the high performance of this assay, the further need for confirmatory intestinal biopsies will be reassessed.
Cellular & Molecular Immunology (2011) 8, 146149; doi:10.1038/cmi.2010.63; published online 14 February 2011
Keywords: celiac disease diagnosis; intestinal histopathology; sensitivity; specificity; tissue transglutaminase
INTRODUCTIONCeliac disease (CD) is an autoimmune-mediated enteropathy caused by permanent gluten intolerance in susceptible individuals.1,2 The preval
ence of CD in the Western world has been increasing steadily, and it is now recognized as a common disorder.3 Its incidence has increased due to recognition of atypical CD forms4 and the identification of...