By Lorraine L. Janeczko
NEW YORK (Reuters Health) - 9/1/2019
Serology has gained importance in the diagnosis of celiac disease (CD), due to improvements in assay performance over the last decade, according to updated advice for clinical practice.
"This expert review addresses advances in the detection and diagnosis of celiac disease. It is clear that blood tests have become an indispensable and usually initial test to detect celiac disease," co-author Dr. Joseph A. Murray of Mayo Clinic in Rochester, Minnesota, told Reuters Health by email.
CD diagnosis relies on symptom recognition, serology and histological analysis of duodenal biopsies, Dr. Murray and colleagues write note in their Best Practice Advice report in Gastroenterology, online December 19.
"In children and adolescents, repeated serological testing with high TG2-IgA levels may render a gastroscopy with biopsy unnecessary. Cases with IgA-deficiency deserve special recognition. Treatment consists foremost of a GFD (gluten-free diet)," they explain. "It is important not to initiate a GFD before measurement of antibodies and biopsy. Follow-up secures the avoidance of long-term side effects of the GFD and aids the adherence to the GFD. The utility of serology vs. histology in follow-up has not been definitively settled."
The researchers reviewed published evidence, including cohort and case-control studies of CD diagnosis and controlled and descriptive studies of CD management.
Their recommendations highlight the following points:
SOURCE: https://bit.ly/2FiS0Xj Gastroenterology 2018.