Celiac Disease by the Numbers

Celiac disease (gluten enteropathy) is a chronic disease of autoimmune genesis caused by eating gluten, which carries HLA-DQ2 and/or -DQ8 alleles, therefore this disease can be transmitted genetically.

When the body is intolerant to gluten, there is a specific lesion of the walls of the small intestine, leading to atrophy of its villi, which is characterized by symptoms such as abdominal bloating, vomiting, weight loss. It is important to note that in most cases celiac disease can proceed without intestinal manifestations, and for this reason 1 out of 4 patients remained without a confirmed diagnosis. However, since the identification of specific markers of celiac disease, the presence of antibodies against tissue transglutaminase and deaminated gliadin peptides, the prevalence of celiac disease has been much higher than anticipated. According to the WHO, the global prevalence of gluten intolerance is 1% of the world's population.

Diagnosis of Celiac Disease Without Biopsy

Until 2012, a biopsy of the small intestine, followed by confirmation of intestinal wall atrophy, was a mandatory requirement for the diagnosis of celiac disease. However, according to recent controversial guidelines, the diagnosis can be made without biopsy in certain circumstances, especially in children. 

Over the past decade, the unambiguity of histological analysis has been questioned and a strong correlation between levels of tissue transglutaminase antibody titer and the severity of mucosal lesions has been recognized.

In 2012, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) published new diagnostic criteria for celiac disease that allows the diagnosis of celiac disease without biopsy with symptoms and levels of immunoglobulin A against tissue transglutaminase which is 10 or more times the upper limit of normal.

Evidence in favor of this approach has been largely based on small studies.

The results of the ProCeDE diagnostic study show that the non-biopsy ESPGHAN approach allows a correct diagnosis of celiac disease. At least 50% of patients in clinical practice will benefit from this non-biopsy approach, which reduces the burden and risks of endoscopy for small bowel biopsy and anesthesia, while saving costs for health care systems.

Based on the results, it can be concluded that the new ESPGHAN diagnostic criteria for skipping biopsy allow a correct diagnosis of celiac disease in symptomatic children if tissue transglutaminase IgA levels are 10 or more times the upper normal limit, and therefore biopsy is not necessary in these children.