One Blood Test Can Now Diagnose Celiac Disease without Biopsy

4 hours ago, Scott Adams said:

A biopsy would still be needed for 5% of people per the article, and the standard tTG test is 95% accurate in diagnosing celiac disease--thus 95% of people can avoid biopsy. That is a great thing! Who wants to undergo a risky procedure that could give them an infection or subject them to a risk from the anesthesia?

Yes, you quoted the article you penned, but I am quoting what the British Society of Gastroenterology has directed for diagnosing celiac disease this year:

“In guidance on restarting endoscopy services the BSG has suggested treating patients (< 55 years) with suspected coeliac disease and a tTG >x10ULN without biopsy.

Here is the protocol further detailing this advice, which is specific to the COVID-19 environment and has been issued as interim guidance pending the publication of the new BSG Coeliac Guideline expected to be published in 2021.”

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I think you were misled by the Daily Mail who stated incorrectly:

“A report by British researchers, soon to be published in leading gastroenterology journal Gut, shows that the blood test alone is 95 per cent accurate for diagnosing the condition.“

I think the TTG has a 95% sensitivity rate to celiac disease.  That is true.  

We’ve published multiple studies on why biopsies need only be the exception and not the rule when diagnosing celiac disease, and blood testing will become the new gold standard, not biopsy. In Europe they are already switching to no-biopsy diagnoses in children and adolescents, and this change was pre-covid:

 There is no indication that the UK will ever go back to a biopsy requirement after covid...I seriously doubt it. I’m not sure why you’re not able to accept this, but this is the future of diagnosing CD, and is good news.

This is also old news, as we’ve published many research summaries on this topic over the years, so it should be no surprise:

https://www.celiac.com/search/?&q=biopsy&type=cms_records2&search_and_or=and&search_in=titles 

My contribution to this thread is inspired by Dr. Guandalini who is a world renowned expert

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I have spoken recently to him and his opinion is that biopsies are widely overused in the US because the blood tests are in most situations sufficient. In a situation like this one, a gluten-free diet will be recommended regardless of the outcome of the biopsy. 

On 9/30/2020 at 11:38 AM, Guest ANTHONY COLATRELLA said:

This is a VERY DECEIVING headline---if you actually read the entire summary in the DAILY MAIL you will clearly see this is just "A TEMPORARY" maneuver by the British GI society in attempt to help take some pressure off an overwhelmed endoscopy system due to the pandemic---they are simply just going to rely on a markedly elevated TTg to diagnose celiac disease and forego the endoscopy---FOR NOW---presumably until their endoscopy schedules "catch up"---whenever that will be---their endoscopy schedules are normally backed up because of their medical system--even without the pandemic.  At that time they will review the data and decide how to proceed.  This is the same TTg test that has been used for the last 10 tears or more to diagnose celiac disease---it is not a new or different test! I think the pandemic has essentially forced them to take a "little short-cut" here!  Do not look for this to happen in the US in the near future 

There is no indication that this move is temporary, and I seriously doubt that it is. This move will save money, still provide celiac disease diagnoses that are 95% accurate. Europeans switched to this model, even before covid, for diagnosing children and adolescents:

 Studies have already been published that show that low biopsy rates drive our current low diagnosis rate, so the changes are very positive in terms of increasing the diagnosis rate:

21 hours ago, Scott Adams said:

We’ve published multiple studies on why biopsies need only be the exception and not the rule when diagnosing celiac disease, and blood testing will become the new gold standard, not biopsy. In Europe they are already switching to no-biopsy diagnoses in children and adolescents, and this change was pre-covid:

 There is no indication that the UK will ever go back to a biopsy requirement after covid...I seriously doubt it. I’m not sure why you’re not able to accept this, but this is the future of diagnosing celiac disease, and is good news.

This is also old news, as we’ve published many research summaries on this topic over the years, so it should be no surprise:

https://www.celiac.com/search/?&q=biopsy&type=cms_records2&search_and_or=and&search_in=titles 

I am not disputing the need for biopsies or not.   I am disputing the summary published on Celiac.com that contains incorrect information.    I encourage you to read the original source on the topic of diagnosing celiac disease by blood test only following the current BSG guidelines:
 

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The new British guidelines are temporary, were due to the backlog of endoscopies due to the pandemic,  and will reviewed in 2021.  You can read them here from the direct source, The British Society of Gastroenterologists.  I am not familiar with the U.K. healthcare system, but I believe the NHS follows the recommendations of the BSG organization.  
 

While these guidelines are temporary, they may become permanent (based on the latter part of the BSG article about collecting data and to help determine if this is a successful approach).  

Nothing in our article is incorrect. The link you posted does not say the guidelines are temporary, and they have not posted any end date to the current changes. They are the current guidelines for diagnosing celiac disease in the UK--which doesn't include biopsy for the vast majority of celiacs. If the guidelines change we will post an article about such changes. 

It is important for those of us in the USA to remember that the UK is NHS based run system. Their current guidelines/test match their system not ours. It is still informative for all of us as a community to know what other countries develop, use, change in diagnosing and/or treatment.

I would offer that it would be helpful to clarify the source of such news/science articles as well as to point out the differences in legality between the source country and the site.  [Is Celiac.com a US-based company? Canada?  (It's times like this when I wish we just had a global community and stopped with all the individual country nonsense.)]

Celiac.com is a USA-based site, but the trend to rely on blood tests to diagnose celiac disease is growing in popularity in all countries. Multiple studies done over the last 15 years have shown this to be an accurate way to make a diagnosis in most cases, provided the blood tests are done using the recommended protocol:

Only a minority of blood tests that meet certain criteria need a follow up biopsy for confirmation. 

Also, doing a biopsy in all cases can lead to many issues, because studies have shown that biopsy results are far more prone to incorrect interpretation than blood tests. So what happens, for example, if you have strong positive blood tests, but the biopsy is negative? No celiac disease, right? The autoimmune reaction is clearly happening that will lead to gut damage. Is it better to wait until that stage, or stop the autoimmune reaction earlier? 

Here is a 2017 UK study that indicates that 4 of more biopsy samples are needed to avoid misdiagnoses, and during the study time period "The proportion of patients who had ≥4 biopsy specimens submitted increased from 21.9% to 60.8%." So at the start of this study time period almost 80% of biopsies done did not take enough samples to make an accurate diagnosis, and at the end period there were still over 20% that did not do this. It is studies like these that clearly show the problem with relying on biopsy to diagnose CD. Additionally there are many people who will never undergo a biopsy to get diagnosed, thus the still very high  under-diagnosis rate. 

 Amazingly, in the USA this 2015 study was done that indicates only one sample needs to be taken, so the studies on biopsy are really all over the place, and sometimes don't make sense, or contradict one another, unlike many of the studies done on blood test accuracy:

On 9/28/2020 at 4:56 PM, Guest Kansas said:

Okay, but how do I get this blood test?? Is it available in the US yet?

 

On 10/13/2020 at 11:31 AM, Scott Adams said:

Celiac.com is a USA-based site, but the trend to rely on blood tests to diagnose celiac disease is growing in popularity in all countries. Multiple studies done over the last 15 years have shown this to be an accurate way to make a diagnosis in most cases, provided the blood tests are done using the recommended protocol:

Only a minority of blood tests that meet certain criteria need a follow up biopsy for confirmation. 

Also, doing a biopsy in all cases can lead to many issues, because studies have shown that biopsy results are far more prone to incorrect interpretation than blood tests. So what happens, for example, if you have strong positive blood tests, but the biopsy is negative? No celiac disease, right? The autoimmune reaction is clearly happening that will lead to gut damage. Is it better to wait until that stage, or stop the autoimmune reaction earlier? 

Here is a 2017 UK study that indicates that 4 of more biopsy samples are needed to avoid misdiagnoses, and during the study time period "The proportion of patients who had ≥4 biopsy specimens submitted increased from 21.9% to 60.8%." So at the start of this study time period almost 80% of biopsies done did not take enough samples to make an accurate diagnosis, and at the end period there were still over 20% that did not do this. It is studies like these that clearly show the problem with relying on biopsy to diagnose celiac disease. Additionally there are many people who will never undergo a biopsy to get diagnosed, thus the still very high  under-diagnosis rate. 

 Amazingly, in the USA this 2015 study was done that indicates only one sample needs to be taken, so the studies on biopsy are really all over the place, and sometimes don't make sense, or contradict one another, unlike many of the studies done on blood test accuracy:

 

Absolutely. Just request it from your physician. Really, there is a whole antibody panel of tests that can/should be run to test for celiac disease but the ttg is now considered the center piece. Open Original Shared Link. Go armed with this information when you visit your physician. Many general practitioners are not up on celiac disease.