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The Role of an IgA/IgG-Deamidated Gliadin Peptide Point-of-Care Test in Predicting Persistent Villous Atrophy in Patients With Celiac Disease on a Gluten-Free Diet

Lau, Michelle S MBChB, MRCP1; Mooney, Peter D MBChB, MRCP, MD1; White, William L BMedSci1; Rees, Michael A BMedSci1; Wong, Simon H MBChB1; Kurien, Matthew MBChB, MRCP, MD1; Trott, Nick BSc (Hon)1; Leffler, Daniel A MD, MS2; Hadjivassiliou, Marios MBChB, MD, FRCP1; Sanders, David S MBChB, MD, FACG, FRCP1

American Journal of Gastroenterology: December 2017 - Volume 112 - Issue 12 - p 1859–1867
doi: 10.1038/ajg.2017.357
ORIGINAL CONTRIBUTIONS: SMALL BOWEL
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Objectives: Mucosal healing is important in celiac disease (CD) for the prevention of complications. However, obtaining duodenal biopsies is invasive, and there is currently no reliable surrogate marker for histological remission in clinical practice. We aimed to assess the role of a point-of-care test (POCT) based on IgA/IgG-deamidated gliadin peptide, in detecting persistent villous atrophy (VA) in CD.

Methods: We prospectively recruited patients with CD attending endoscopy for the assessment of histological remission. All patients had IgA-endomysial (EMA) antibodies, IgA-tissue transglutaminase (TTG) antibodies, and the POCT performed, and completed a validated dietary adherence questionnaire. A gastroscopy was performed in all patients, with four biopsies taken from the second part of the duodenum and one from the duodenal bulb. We compared the diagnostic performance of the surrogate markers against duodenal histology as the reference standard.

Results: A total of 217 patients with CD (70% female, age range 16–83 years, median age 53 years) on a gluten-free diet (median duration 6 years) were recruited from 2013 to 2017. Eighty-five (39.2%) patients had persistent VA. The sensitivities of the POCT, TTG, EMA, and the adherence score in detecting VA were 67.1%, 44.7%, 37.7%, and 24.7% respectively (P=0.0005). The combination of the POCT and adherence score only marginally increased the sensitivity to 70.6% (59.7–80.0%).

Conclusions: The sensitivity of the POCT was higher than the other surrogate markers in predicting VA. A POCT may provide the additional advantage of an immediate objective assessment of mucosal healing at the time of an office-based follow-up consultation.

1Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK

2Celiac Center and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

Correspondence: Michelle Shui Yee Lau, MBChB, MRCP, Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Room P18, Sheffield S10 2JF, UK. E-mail: michellelau@doctors.org.uk

Received 24 May 2017; accepted 05 August 2017

Guarantor of the article: David Sanders, MBChB, MD, FACG, FRCP.

Specific author contributions: M.S.L.: data collection, analysis and interpretation of the data, statistical analysis, and drafting of the manuscript. P.D.M.: data collection, and analysis and interpretation of the data. W.L.W., M.A.R., and S.H.W.: data collection. N.T., D.L., M.H., and M.K.: revision of the manuscript. D.S.S.: study concept and design, revision of the manuscript, and study supervision. All authors have approved the final draft submitted.

Financial support: None.

Potential competing interests: Professor Sanders has received educational research grants from Dr Schaer (a gluten-free food manufacturer) and Tillotts Pharma (distributor of a POCT for CD) for investigator led studies. Dr Schaer and Tillott’s Pharma did not have any input in the study design, access to study data, interpretation of the findings, or drafting of the manuscript. Daniel Leffler is a Medical Director at Takeda Pharmaceuticals. Takeda Pharmaceuticals did not have any input in the study design, access to study data, interpretation of the findings, or drafting of the manuscript. All other authors declare no conflicts of interest.

© The American College of Gastroenterology 2017. All Rights Reserved.
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