Oral Presentation International Celiac Disease Symposium 2026

Accuracy of New European Adult Guidelines for Serology-Based Diagnosis of Celiac Disease in a United States Population (141251)

Claire Jansson-Knodell 1 , Andrew Ford 1 , Elizabeth N Dewey 1 , Jay Patel 1 , Arjun Chatterjee 1 , James Scantling 1 , Matthew Kerosky 1 , Ivan Yu 1 , Jongsup Lee 2 , Adam C Bledsoe 2 , Rok Seon Choung 2 , Joseph A Murray 2 , Amelie Therrien 3 , Emma Frank 3 , Noah Lustbader 4 , Miles J Basil 4 , Dawn Adams 4 , Haley M Zylberberg 5 , Benjamin Lebwohl 5 , Yichun Fu 6 , Sonia S Kupfer 6 , Jarrod E Dalton 1 , Alberto Rubio-Tapia 1
  1. Cleveland Clinic, Cleveland, OH, United States
  2. Mayo Clinic, Rochester, MN, United States
  3. Beth Israel Deaconess Medical Center, Boston, MA, United States
  4. Vanderbilt University Medical Center, Nashville, TN, United States
  5. Columbia University Medical Center, New York, NY, United States
  6. University of Chicago, Chicago, IL, United States

Background and Aims: We aimed to determine the diagnostic accuracy of the conditional recommendation for a non-biopsy diagnosis for adults (age <45) from the newly released European Society for the Study of Celiac Disease guidelines in a United States (US) adult population.

Methods: We performed a multicenter cohort study encompassing 6 academic medical centers across the US.  Inclusion criteria were adults (≥18 years) evaluated for celiac with tissue transglutaminase immunoglobulin A antibody (tTG-IgA) and duodenal biopsy.  Exclusion criteria were prior celiac diagnosis, IgA deficiency, and patients following a gluten-free diet.  Celiac disease was defined as biopsy showing villous atrophy (Marsh ≥3).  Diagnostic performance was measured with specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV).

Results: A total of 13,374 patients were included with 6,617 between 18-45 years old.  There were 515 patients with tTG-IgA ≥10x the upper limit of normal (ULN) in all age groups with 249 of those patients aged 18-45.  All but 6 of those 249 patients had villous atrophy on biopsy (97.6%).  The cutoff of ≥10x ULN was 99.8% (95% CI, 99.8%, 100%) specific for a diagnosis of celiac disease [Table 1].  The unadjusted PPV was 0.98.  The sensitivity was 18.6% (95% CI, 16.5%, 20.7%) and the unadjusted NPV was 0.83.  If a prevalence of 1% is assumed, the adjusted PPV was 0.62 and adjusted NPV was 0.99.  

Conclusions: A tTG-IgA ≥10x ULN strongly correlates with villous atrophy suggesting the non-biopsy diagnosis proposed by European guidelines may be accurate in US adults; however, it would apply to approximately 20% of patients ultimately diagnosed with celiac disease and 4% of all patients evaluated for celiac disease in our sample.

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