Esophagus to Small Intestine
Aliment Pharmacol Ther. 2022;55(5):514–27
Systematic review with meta-analysis: The accuracy of serological tests to support the diagnosis of celiac disease
Background: There is growing support for a biopsy avoidant approach to diagnose celiac disease in both children and adults, using a serological diagnosis instead.
Aims: To assess the diagnostic accuracy of serological tests for celiac disease in adults and children.
Methods: Seven electronic databases were searched between January 1990 and August 2020. Eligible diagnostic studies evaluated the accuracy of serological tests for celiac disease against duodenal biopsy. Risk of bias assessment was performed using QUADAS-2. Bivariate random-effects meta-analyses were used to estimate serology sensitivity and specificity at the most commonly reported thresholds.
Results: 113 studies (n = 28,338) were included, all in secondary care populations. A subset of studies was included in meta-analyses due to variations in diagnostic thresholds. Summary sensitivity and specificity of immunoglobulin A (IgA) anti-tissue transglutaminase were 90.7% (95% confidence interval [CI]: 87.3–93.2%) and 87.4% (95% CI: 84.4–90.0%) in adults (5 studies) and 97.7% (95% CI: 91.0–99.4%) and 70.2% (95% CI: 39.3–89.6%) in children (6 studies); and of IgA endomysial antibodies were 88.0% (95% CI: 75.2–94.7%) and 99.6% (95% CI: 92.3–100%) in adults (5 studies) and 94.5% (95% CI: 88.9–97.3%) and 93.8% (95% CI: 85.2–97.5%) in children (5 studies).
Conclusions: Anti-tissue transglutaminase sensitivity appears to be sufficient to rule out celiac disease in children. The high specificity of endomysial antibody in adults supports its use to rule in celiac disease. This evidence underpins the current development of clinical guidelines for a serological diagnosis of celiac disease. Studies in primary care are needed to evaluate serological testing strategies in this setting.