J Pediatr Gastroenterol Nutr. 2024 May 20. doi: 10.1002/jpn3.12251. Online ahead of print.

Simon Klöti ¹, Joachim Schaad ^1 2, Johannes Spalinger ^1 2, Susanne Schibli ², Lara Hart ³, Christiane Sokollik ², Franziska Righini-Grunder ¹

Author information

¹Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Hospital of Central Switzerland, Lucerne, Switzerland.

²Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

³Division of Pediatric Gastroenterology, Hepatology and Nutrition, McMaster University, Hamilton, Ontario, Canada.

Abstract

Objectives: European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines enable the diagnosis of celiac disease (CD) without biopsies in patients with immunoglobulin A (IgA)-antibodies against tissue transglutaminase (TGA-IgA) ≥ 10× the upper limit of normal (ULN) and positivity of endomysial antibodies in a second blood sample. Limited data exist comparing the biopsy versus the nonbiopsy diagnostic approach regarding long-term outcomes in CD patients. Our study aimed to investigate the influence of the diagnostic approach on adherence to gluten-free diet (GFD), serological remission (defined as normalization of TGA-IgA during follow-up (FU)) and clinical remission in CD patients with TGA-IgA ≥ 10× ULN.

Methods: Retrospective multicenter study. Patients with CD and TGA-IgA ≥ 10× ULN at diagnosis were included in the study. Patients with confirmed diagnosis by biopsy were compared to patients diagnosed by nonbiopsy approach using univariate analysis, Kaplan-Meier survival curve, and logistic regression models.

Results: A total of 282 CD patients (192 [68.1%] in the biopsy group; 90 [31.9%] in the nonbiopsy group) were analyzed. The median time to normalization of TGA-IgA was 16.5 months [interquartile range, IQR: 13, 28] in the biopsy and 15 months [IQR: 12, 26] in the nonbiopsy group; p = 0.14). Rates of normalized TGA-IgA at first to third-year FU were comparable between both groups. Adherence to GFD did not seem to be influenced by the diagnostic approach.

Conclusions: The nonbiopsy approach is not inferior to the biopsy approach in terms of adherence to GFD and serological remission in patients with CD.