Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy.
Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy.
World J Gastroenterol. 2021 Nov 14;27(42):7233-7239. doi: 10.3748/wjg.v27.i42.7233.
The diagnosis of coeliac disease (CD) in adult patients requires the simultaneous assessment of clinical presentation, serology, and typical histological picture of villous atrophy. However, several years ago, the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines approved new criteria for the diagnosis in children: Biopsy could be avoided when anti-transglutaminase antibody (TGA) values exceed the cut-off of × 10 upper limit of normal (ULN) and anti-endomysium antibodies are positive, independently from value. This "no biopsy" approach is a decisive need for pediatric population, allowing to avoid stressful endoscopic procedures in children, if unnecessary. This approach relies on the correlation existing in children between TGA levels and assessment of mucosal atrophy according to Marsh's classification. Several lines of evidence have shown that patients with villous atrophy have markedly elevated TGA levels. Therefore, we aim to perform a narrative review on the topic in adults. Despite that some studies confirmed that the × 10 ULN threshold value has a very good diagnostic performance, several lines of evidence in adults suggest that TGA cut off should be different from that of pediatric population for reaching a good correlation with histological picture. In conclusion, the heterogeneity of study reports as well as some conditions, which may hamper the serological diagnosis of CD (such as seronegative CD and non-celiac villous atrophy) and are much more common in adults than in children, could represent a limitation for the "no biopsy" approach to CD diagnosis in patients outside the pediatric age.
乳糜泻（CD）的诊断在成人患者中需要同时评估临床表现、血清学和典型的绒毛萎缩组织学表现。然而，几年前，欧洲儿科胃肠病学、肝病学和营养学会指南批准了儿童诊断的新标准：当抗转谷氨酰胺酶抗体（TGA）值超过×10 上限正常（ULN）且抗内肌膜抗体阳性时，即使活检也可以避免，无论 TGA 值如何。这种“无活检”方法对于儿科人群是一个决定性的需求，可避免在不必要的情况下对儿童进行有压力的内镜检查。这种方法依赖于儿童中 TGA 水平与根据 Marsh 分类评估黏膜萎缩之间的相关性。有几条证据表明，绒毛萎缩患者的 TGA 水平显著升高。因此，我们旨在对成人进行叙述性综述。尽管一些研究证实×10 ULN 阈值具有很好的诊断性能，但成人的一些研究表明，TGA 截止值应与儿科人群不同，以与组织学图片达到良好的相关性。总之，研究报告的异质性以及可能阻碍 CD 血清学诊断的一些情况（如血清阴性 CD 和非乳糜泻绒毛萎缩）在成人中比在儿童中更为常见，这可能代表了在儿科年龄之外的患者中 CD 诊断的“无活检”方法的一个限制。
