Confirming celiac disease is getting easier | Image credit: Contemporary Pediatrics

Published in Journal of Pediatric Gastroenterology and Nutrition

In the wake of the no-biopsy approach to diagnosing celiac disease (CD) introduced in the 2012 European Society for Paediatric Gastroenterology and Hepatology and Nutrition guidelines, Israeli investigators demonstrated that a repeated anti–tissue transglutaminase-2 (anti-TG2) test could replace the antiendomysial antibody (EMA) test required by the guidelines as the confirmatory serology test for diagnosing CD.

In a retrospective study, investigators compared EMA positivity and high-positive anti-TG2 in 933 patients whose confirmatory EMA test was given within 2 months of their first high-positive anti-TG2 test. All 933 patients who had high-positive anti-TG2 serology more than 10 times the upper limit of normal in their first sample had both high-positive anti-TG2 and positive EMA. In fact, most (99.6%) had extremely high EMA titers in their confirmatory test. Investigators noted that this no-biopsy approach—repeating an anti-TG2 test instead of the EMA test as the confirmatory serology test for a CD diagnosis—would be especially useful in low-resource settings and in centers that do not have access to a high-quality immunology lab.

THOUGHTS FROM DR FARBER

We are getting away from biopsies to diagnose CD, which makes diagnosis even easier; it will be especially valuable in underserved areas. Note that anti-TG2 levels must be markedly elevated to be considered abnormal. Not commented on in the article, remember that TTG testing is also useful for detecting a response to a gluten-free diet.

Reference:

Ben-Tov A, Achler T, Fayngor R, et al. Endomysial antibodies or anti-tissue transglutaminase type 2 IgA antibodies as a confirmatory test in children with celiac disease. J Pediatr Gastroenterol Nutr. 2025;80(1):147-150. doi:10.1002/jpn3.12383