J Pediatr Gastroenterol Nutr. 2024 Oct 13. doi: 10.1002/jpn3.12383. Online ahead of print.

Amir Ben-Tov ^1 2 3, Tomer Achler ³, Rochelle Fayngor ³, Raanan Shamir ^3 4, Lia Supino ⁵, Yael Weintraub ^3 4, Anat Yerushalmy-Feler ^2 3, Shlomi Cohen ^2 3

Author information

¹Maccabi Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel.

²Tel-Aviv Sourasky Medical Center, Dana-Dwek Children's Hospital, Pediatric Gastroenterology Institute, Tel Aviv, Israel.

³School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv, Israel.

⁴Schneider Children's Medical Center, Institute of Pediatric Gastroenterology, Nutrition, and Liver Diseases, Petah Tikva, Israel.

⁵Immunology Unit, National Laboratory, Maccabi Healthcare Services, Rechovot, Israel.

Abstract

The no-biopsy approach to diagnose celiac disease (CD), introduced in the 2012 European Society for Gastroenterology and Hepatology and Nutrition guidelines, requires an anti-endomysial antibody (EMA) confirmatory serology test following a high-positive immunoglobulin A anti-tissue transglutaminase-2 (anti-TG2) antibody ≥10 times the upper limit of normal (ULN). The aim of this retrospective study is to compare EMA positivity and high-positive anti-TG2 in patients who had their confirmatory test within two month of their first high-positive anti-TG2 test. Among 933 patients who had high-positive anti-TG2 serology more than 10 times the ULN in their first sample, all had both high-positive anti-TG2 and positive EMA, most of them with very high EMA titers (99.6%) in their confirmatory test. In conclusion, we suggest that a repeated anti-TG2 test can replace the EMA test as the confirmatory serology test for the confirmation of the diagnosis of CD in the no-biopsy approach.