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While people with high-risk symptoms of coeliac disease need biopsies, people with low-risk symptoms can be diagnosed just with a blood test, say researchers.
17 04 2007
Coeliac disease is a sensitivity to gluten with problems from weight loss to diarrhoea to fatigue to bone thinning to infertility. It's underdiagnosed which means people are sicker than they need to be and at are risk of lymphoma - which is preventable by a gluten-free diet.
Diagnosing coeliac disease relies on a small bowel biopsy, but there are also antibody tests. British doctors wanted to see if they could identify people who really needed a biopsy and those who could safely have just an antibody blood test called tissue transglutaminase.
They found that people with high-risk symptoms of weight-loss, anaemia and diarrhoea should have a biopsy regardless of the blood test. And that people with low risk symptoms - basically everyone else - could be screened with the antibody.
If the low risk people were negative on the blood test, not one of them had coeliac therefore in fact wouldn't have needed a biopsy. If antibody positive then it doubled the chances of a positive biopsy.
It's a way of reducing unnecessary biopsies. The problem with starting a gluten-free diet blind, as many people do, is that if you really do have coeliac disease then it's a diet for life so you need to know the diagnosis.
Title: British Medical Journal 2007;334:729-732
Author: Hopper AD et al. Pre-endoscopy serological testing for coeliac disease: evaluation of a clinical decision tool.
Title: British Medical Journal 2007;334:704-705
Author: Jones R. Coeliac disease in primary care is common, underdiagnosed and can present with non-specific symptoms.
Title: New England Journal of Medicine 2007;356:1121-1129
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