Ottobre 2011 - Volume XXX - numero 8
Ricerca
1Clinica Pediatrica, IRCCS Pediatrico “Burlo Garofolo”, Università di Trieste
2Servizio di Epidemiologia e Biostatistica, 3Laboratorio di Immunopatologia Clinica, IRCCS Pediatrico “Burlo Garofolo”, Trieste
Indirizzo per corrispondenza: elisa.benelli@gmail.com
Key words: Coeliac disease, Diagnosis, Biopsy, IgA anti-tTG, EMA antibodies, Systematic review
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.
Vuoi citare questo contributo?