A new study in Finland concluded celiac disease can be diagnosed accurately without a biopsy in some adults. These patients must score a triple positive on blood tests: 10 times the normal upper limit of tissue transglutaminase antibodies, positive for endomysial antibodies and a positive genetic test. In the study from University of Tampere, one-third of new celiac patients could have been diagnosed conclusively without a biopsy.
The group included 421 high-risk adults suspected of having celiac, 2,357 at moderate risk who were tested due to a family member having celiac and 2,722 low-risk individuals identified in a general population study. All participants underwent the three blood tests and a biopsy.
The tests diagnosed celiac in 274 people, with 90 meeting the triple positive criteria. In this latter group, biopsies proved blood tests diagnosis alone would have been 100 percent accurate. Triple positive diagnosis was possible in 37 percent of the high-risk, 20 percent of medium-risk and 48 percent of low-risk patients.
This large study of Finnish adults provides strong evidence for accurate diagnosis without biopsy. The authors advocate using non-invasive tests when appropriate in adults to save medical costs without sacrificing accuracy.
European gastroenterologists previously recommended the triple positive standard but only for children suspected of having celiac due to symptoms such as diarrhea. North American experts still disagree on its reliability, with some still holding biopsy as the gold standard. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition has not yet endorsed celiac diagnosis without biopsy.