Point-of-care test predicts persistent villous atrophy in celiac disease

Reuters Health Information: Point-of-care test predicts persistent villous atrophy in celiac disease

Point-of-care test predicts persistent villous atrophy in celiac disease

Last Updated: 2017-10-30

By Will Boggs MD

NEW YORK (Reuters Health) - A point-of-care (POC) test based on IgA/IgG-deamidated gliadin peptide (DGP) accurately predicts persistent villous atrophy in patients with celiac disease who follow a gluten-free diet, researchers report.

"We are currently lacking a reliable non-invasive method for disease monitoring for known celiac patients," Dr. Michelle Shui Yee Lau from Royal Hallamshire Hospital, Sheffield Teaching Hospitals, UK, told Reuters Health by email. "What is very interesting is although tissue transglutaminase (TTG) serology and the DGP point-of-care test have similarly high sensitivities in detecting celiac disease, the DGP point-of-care test significantly outperformed TTG serology in predicting histological remission in known celiac patients."

Remission rates in celiac patients range from 34% to 65% at 2 years after diagnosis, and persistent villous atrophy can increase the risk of lymphoproliferative malignancies and hip fractures. Several POC tests have been developed to detect celiac antibodies, but few studies have investigated their potential role in disease monitoring.

Dr. Lau and colleagues evaluated the diagnostic performances of Simtomax, a commercially available DGP-based POC test; TTG; endomysial antibodies (EMA); and an adherence questionnaire in predicting persistent villous atrophy in 217 patients with celiac disease on a gluten-free diet.

The findings were published online October 10 in the American Journal of Gastroenterology. The study had no funding from the test maker.

Eighty-five participants (39.2%) had persistent villous atrophy, as determined by duodenal histology. The sensitivity of the DGP test for predicting persistent villous atrophy was 67.1%, compared with 44.7% for TTG, 37.7% for EMA, and 24.7% for the adherence score. Combining the adherence score with the DGP test marginally increased the sensitivity to 70.6%.

Using positive DGP results as an indication for duodenal biopsy would save $244.92 ( 187.39) per case of villous atrophy detected, compared with routine duodenal biopsy for all patients, but it would miss 28 of the 85 cases detected by routine duodenal biopsy.

"The DGP point of care test is superior to conventional serology which we are currently using for disease monitoring," Dr. Lau said. "It has the potential to be used as a simple and rapid test during follow-up to target patients who require duodenal biopsies."

"However," she said, "it must be emphasized that the sensitivity of the DGP point of care test is still not high enough to reliably exclude all cases of persistent villous atrophy. Therefore, in patients where ongoing villous atrophy is suspected, duodenal biopsies should be undertaken."

"From the patient's perspective, they are often not keen on endoscopy," Dr. Lau said. "They also like to have instant results indicating the effect of their gluten-free diet and disease remission."

"We think that the DGP point-of-care test would be best suited for use in a follow-up clinic setting," she said. "The rapid availability of the results in real time would allow immediate feedback to the patients and discussion between the clinician and patient regarding onward management. This setup could even be led by a celiac specialist dietician, which may increase the efficiency of the follow-up process."

SOURCE: http://go.nature.com/2yRxHel

Am J Gastroenterol 2017.

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