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A Biopsy Is Not Always Necessary to Diagnose Celiac Disease

Mubarak, Amani*; Wolters, Victorien M*; Gerritsen, Susan AM*; Gmelig-Meyling, Frits HJ; Ten Kate, Fiebo JW; Houwen, Roderick HJ*

Journal of Pediatric Gastroenterology and Nutrition: May 2011 - Volume 52 - Issue 5 - p 554–557
doi: 10.1097/MPG.0b013e3181ef8e50
Original Articles: Gastroenterology

Objectives: Small intestinal histology is the criterion standard for the diagnosis of celiac disease (CD). However, results of serological tests such as anti-endomysium antibodies and anti-tissue transglutaminase antibodies (tTGA) are becoming increasingly reliable. This raises the question of whether a small intestinal biopsy is always necessary. The aim of the present study was, therefore, to investigate whether a small intestinal biopsy can be avoided in a selected group of patients.

Patients and Methods: Serology and histological slides obtained from 283 pediatric patients suspected of having CD were examined retrospectively. The response to a gluten-free diet (GFD) in patients with a tTGA level ≥100 U/mL was investigated.

Results: A tTGA level ≥100 U/mL was found in 128 of the 283 patients. Upon microscopic examination of the small intestinal epithelium, villous atrophy was found in 124 of these patients, confirming the presence of CD. Three patients had crypt hyperplasia or an increased number of intraepithelial lymphocytes. In 1 patient no histological abnormalities were found. This patient did not respond to a GFD.

Conclusions: Pediatric patients with a tTGA level ≥100 U/mL in whom symptoms improve upon consuming a GFD may not need a small intestinal biopsy to confirm CD.

*Departments of Pediatric Gastroenterology, The Netherlands

Immunology, The Netherlands

Pathology, University Medical Center Utrecht, The Netherlands.

Received 9 February, 2010

Accepted 29 June, 2010

Address correspondence and reprint requests to Amani Mubarak, Wilhelmina Children's Hospital, Department of Pediatric Gastroenterology, KE 01.144.3, PO Box 85090, 3508 AB, Utrecht, The Netherlands (e-mail:

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN