ORIGINAL CONTRIBUTIONS: SMALL BOWELAre ESPGHAN “Biopsy-Sparing” Guidelines for Celiac Disease also Suitable for Asymptomatic Patients?Trovato, Chiara Maria MD1; Montuori, Monica MD, PhD1; Anania, Caterina MD1; Barbato, Maria MD1; Vestri, Anna Rita2; Guida, Sofia3; Oliva, Salvatore MD1; Mainiero, Fabrizio MD3; Cucchiara, Salvatore MD, PhD1; Valitutti, Francesco MD1Author Information 1Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy 2Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy 3Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy Correspondence: Francesco Valitutti, MD, Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome 00161, Italy. E-mail: firstname.lastname@example.org Guarantor of the article: Chiara Maria Trovato, MD. Specific author contributions: Chiara Maria Trovato: principal investigator, wrote the paper, contributed to the study design. Monica Montuori, Caterina Anania, and Maria Barbato: involved in patient recruitment and clinical management. Anna Rita Vestri: involved in statistical evaluation and data interpretation. Sofia Guida: involved in evaluation of antibodies. Salvatore Oliva: performed endoscopies and biopsies. Fabrizio Mainiero: revised the paper critically. Salvatore Cucchiara: designed the research study. Francesco Valitutti: reviewed the paper, contributed to the study design. All authors approved the submitted version of the manuscript. Financial support: None. Potential competing interests: None. American Journal of Gastroenterology: October 2015 - Volume 110 - Issue 10 - p 1485-1489 doi: 10.1038/ajg.2015.285 Buy Metrics Abstract OBJECTIVES: In 2012, European Society of Pediatric Gastroenterology, Hepatology, and Nutrition published novel guidelines on celiac disease (CD) diagnosis. Symptomatic children with serum anti-transglutaminase (anti-tTG) antibody levels ≥10 times upper limit of normal (ULN) could avoid duodenal biopsies after positive HLA test and serum anti-endomysial antibodies (EMAs). So far, both asymptomatic and symptomatic patients with anti-tTG titer <10 times ULN should undergo upper endoscopy with duodenal biopsies to confirm diagnosis. The aim of this study was to assess the accuracy of serological tests to diagnose CD in asymptomatic patients. METHODS: We retrospectively reviewed data of 286 patients (age range: 10 months to 17 years) with CD diagnosis based on elevated titer of anti-tTG, EMA positivity, and histology. All patients were distinguished between symptomatic and asymptomatic; histological lesions were graded according to the Marsh–Oberhuber (MO) criteria. Fisher exact test was applied to analyze both groups in terms of diagnostic reliability of serological markers. RESULTS: A total of 196 patients (68.53%) had anti-tTG titers ≥10 times ULN. Among them, a group of 156 patients (79.59%) also had symptoms suggestive of CD (“high-titer” symptomatic); of these, 142 patients (91.02%) showed severe lesion degree (3a, 3b, 3c MO). Conversely, 40 out of 196 patients (20.40%) were asymptomatic (“high-titer” asymptomatic) and 37 patients (92.5%) of them showed severe lesion degree (3a, 3b, 3c MO). No difference in histological damage was found between “high-titer” symptomatic and “high-titer” asymptomatic children (Fisher exact test,P=1.000). CONCLUSIONS: If confirmed in large multicenter prospective studies, the “biopsy-sparing” protocol seems to be applicable to both symptomatic and asymptomatic patients with anti-tTG titer ≥10 times ULN, positive EMA, and HLA-DQ2/DQ8. © The American College of Gastroenterology 2015. All Rights Reserved.