Diagnosi di celiachia: basta con la biopsia?

Introduction - Intestinal biopsy is still considered the referral test for definitive diagnosis of coeliac disease. Nevertheless, according to the new ESPGHAN guidelines, it seems that avoiding the intestinal biopsy in few selected cases could be an option.
Aims and methods - The main aim of the study was to assess, by means of a systematic review of the literature, whether there is enough evidence to assert that coeliac disease can be diagnosed without recurring to the intestinal biopsy at least in those cases with overt symptoms and positive anti-tTG or EMA antibodies. Secondly, the Authors estimated the predictive value of positive anti-tTG and EMA IgA in clinical practice, through a retrospective analysis of a population directly accessing the laboratory of the IRCCS “Burlo Garofolo” (anti-tTG and EMA blood tests being prescribed by the general practitioner). Finally, analyzing the cases in their Institute, the Authors estimated how many coeliac patients could be diagnosed without intestinal biopsy, by applying the new protocol.
Results - From the analysis of the literature (1820 papers initially selected) anti-tTG and EMA IgA resulted having a 100% specificity in the diagnosis of coeliac disease in overtly symptomatic children. Also from the analysis of the population selected through the Institute’s laboratory, the predictive value of concomitant positivity of anti-tTG and EMA IgA resulted practically absolute: 100% in children with typical symptoms, 97% in children without typical symptoms. By applying the new protocol, 50% of the children diagnosed in the Institute in the past 5 years could have received the diagnosis without biopsy.
Conclusions - In children with overt symptoms and high titre anti-tTG and EMA IgA, the diagnosis of coeliac disease may be certain even without biopsy. Prospective studies are needed in order to evaluate the effects of the new protocol in terms of costs and of quality of the management of coeliac patients.