Objective Avoiding duodenal biopsy in adults for coeliac disease (CD) diagnosis is controversial. Some retrospective and prospective studies have shown that CD can be reliably diagnosed in adults with serology rather than duodenal biopsies. This study aimed to check the accuracy of a cut-off value of ≥10 upper limit of normal of anti-tissue transglutaminase antibody (anti-TTG IgA) titres for CD diagnosis in adult patients. Method We retrospectively analysed adult patients (≥16 years) who underwent gastroscopy from 2013 to 2018 for positive coeliac serology. The relationship between titres and disease was determined by using linear models, whereas sensitivity and specificity were assessed by receiver operator curve. Results We analysed 144 newly anti-TTG antibody-positive adult patients with a median age of 48.5 years (IQR 32–62); among them, 86 (60%) patients had CD (Marsh III: n=68 and Marsh II and I: n=18) with a higher prevalence in females (n=59 (69%)) and Europeans (n=60 (70%)). Fifty (58%) patients with CD had colonoscopy and five (6%) had imaging; only six patients were diagnosed with additional conditions. An anti-TTG IgA titre cut-off value of 150 U/L was 100% specific for CD in our dataset, with 70% (95% CI: 60% to 88%) sensitivity for this patient group. Conclusion Coeliac serology using anti-TTG IgA with titres ≥10× normal value is an excellent predictor of CD, irrespective of age, gender and ethnicity. Duodenal biopsy may not be necessary in selected adult patients with CD, especially younger than 50 years of age without additional gastrointestinal red-flag signs and symptoms. Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available upon reasonable request. Restrictions apply to the availability of data from JB with the permission of Counties Manukau Health Research Office.

中文翻译：

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对于具有高抗组织转谷氨酰胺酶 (TTG) 抗体滴度的成年患者的乳糜泻诊断，十二指肠活检是否总是必要的？

目的 避免在成人中进行十二指肠活检以诊断乳糜泻是有争议的。一些回顾性和前瞻性研究表明，CD 可以通过血清学而不是十二指肠活检在成人中可靠地诊断出来。本研究旨在检查抗组织转谷氨酰胺酶抗体（anti-TTG IgA）滴度≥10 正常上限的临界值对成年患者 CD 诊断的准确性。方法 我们回顾性分析了 2013 年至 2018 年接受胃镜检查的乳糜泻血清学阳性的成年患者（≥16 岁）。使用线性模型确定滴度和疾病之间的关系，而通过接受者操作曲线评估敏感性和特异性。结果 我们分析了 144 名新的抗 TTG 抗体阳性成年患者，中位年龄为 48.5 岁（IQR 32-62）；其中，86 名（60%）患者患有 CD（Marsh III：n=68，Marsh II 和 I：n=18），女性（n=59（69%））和欧洲人（n=60（70%）的患病率较高）。五十名 (58%) 的 CD 患者进行了结肠镜检查，五名 (6%) 进行了影像学检查；只有六名患者被诊断出患有其他疾病。在我们的数据集中，150 U/L 的抗 TTG IgA 滴度截止值对 CD 具有 100% 的特异性，该患者组的敏感性为 70%（95% CI：60% 至 88%）。结论 使用滴度≥10 倍正常值的抗 TTG IgA 的乳糜泻血清学是 CD 的极好预测指标，与年龄、性别和种族无关。对于特定的成年 CD 患者，尤其是年龄小于 50 岁且没有其他胃肠道危险信号和症状的患者，可能不需要十二指肠活检。可根据合理要求提供数据。数据可能从第三方获得，并且不公开。支持本研究结果的数据可根据合理要求提供。经 Counties Manukau Health Research Office 许可，限制适用于 JB 提供的数据。