{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T16:56:46Z","timestamp":1776704206220,"version":"3.51.2"},"reference-count":36,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2020,9,8]],"date-time":"2020-09-08T00:00:00Z","timestamp":1599523200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Foundation for Pediatric Research","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"DOI":"10.13039\/501100002341","name":"Academy of Finland","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/501100002341","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006306","name":"Sigrid Jus\u00e9liuksen S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/501100006306","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005744","name":"Lastentautien Tutkimuss\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/501100005744","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Non-biopsy diagnosis of celiac disease is possible in children with anti-transglutaminase 2 antibodies (TGA) &gt; 10\u00d7 the upper limit of normal (ULN) and positive anti-endomysial antibodies (EMA). Similar criteria have been suggested for adults, but evidence with different TGA assays is scarce. We compared the performance of four TGA tests in the diagnosis of celiac disease in cohorts with diverse pre-test probabilities. Serum samples from 836 adults with either clinical suspicion or family risk of celiac disease were tested with four commercial TGA assays, EmA and celiac disease-associated genetics. The diagnosis was set based on duodenal lesion or, in some cases, using special methods. 137 (57%) patients with clinical suspicion and 85 (14%) of those with family risk had celiac disease. Positive predictive value (PPV) for 10\u00d7ULN was 100% in each TGA test. The first non-diagnostic investigations were encountered with ULN 1.0\u00d7\u20135.1\u00d7 in the clinical cohort and 1.3\u00d7\u20134.9\u00d7 in the family cohort, respectively. Using the assays\u2019 own cut-offs (1\u00d7ULN) the PPVs ranged 84\u2013100%. Serology-based diagnosis of celiac disease was accurate in adults using different commercial kits and pre-test probabilities using 10\u00d7ULN. The results also suggest that the ULN threshold for biopsy-omitting approach could be lower.<\/jats:p>","DOI":"10.3390\/nu12092736","type":"journal-article","created":{"date-parts":[[2020,9,8]],"date-time":"2020-09-08T09:03:48Z","timestamp":1599555828000},"page":"2736","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Non-Biopsy Serology-Based Diagnosis of Celiac Disease in Adults Is Accurate with Different Commercial Kits and Pre-Test Probabilities"],"prefix":"10.3390","volume":"12","author":[{"given":"Venla","family":"Yl\u00f6nen","sequence":"first","affiliation":[{"name":"Celiac Disease Research Centre, Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7417-5151","authenticated-orcid":false,"given":"Katri","family":"Lindfors","sequence":"additional","affiliation":[{"name":"Celiac Disease Research Centre, Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marleena","family":"Repo","sequence":"additional","affiliation":[{"name":"Celiac Disease Research Centre, Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"},{"name":"Tampere Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"},{"name":"Department of Pediatrics, Tampere University Hospital, 33520 Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1372-430X","authenticated-orcid":false,"given":"Heini","family":"Huhtala","sequence":"additional","affiliation":[{"name":"Faculty of Social Sciences, Tampere University, 33520 Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valma","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Celiac Disease Research Centre, Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P\u00e4ivi","family":"Saavalainen","sequence":"additional","affiliation":[{"name":"Research Programs Unit, Immunobiology, and Haartman Institute, Department of Medical Genetics, University of Helsinki, 00014 Helsinki, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Musikka","sequence":"additional","affiliation":[{"name":"Celiac Disease Research Centre, Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaija","family":"Laurila","sequence":"additional","affiliation":[{"name":"Tampere Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katri","family":"Kaukinen","sequence":"additional","affiliation":[{"name":"Celiac Disease Research Centre, Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"},{"name":"Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4757-2164","authenticated-orcid":false,"given":"Kalle","family":"Kurppa","sequence":"additional","affiliation":[{"name":"Tampere Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"},{"name":"Department of Pediatrics, Tampere University Hospital, 33520 Tampere, Finland"},{"name":"The University Consortium of Sein\u00e4joki, 66320 Sein\u00e4joki, Finland"},{"name":"Department of Pediatrics, Sein\u00e4joki Central Hospital, 66320 Sein\u00e4joki, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,9,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-230X-9-49","article-title":"Increasing prevalence and high incidence of celiac disease in elderly people: A population-based study","volume":"9","author":"Vilppula","year":"2009","journal-title":"BMC Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.gtc.2018.09.007","article-title":"Celiac disease in Asia","volume":"48","author":"Makharia","year":"2019","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Taavela, J., Koskinen, O., Huhtala, H., L\u00e4hdeaho, M.-L., Popp, A., Laurila, K., Collin, P., Kaukinen, K., Kurppa, K., and M\u00e4ki, M. (2013). Validation of morphometric analyses of small-intestinal biopsy readouts in celiac disease. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0076163"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1155\/2008\/905325","article-title":"Pearls and pitfalls in the diagnosis of adult celiac disease","volume":"22","author":"Freeman","year":"2008","journal-title":"Can. J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/MPG.0000000000002497","article-title":"European Society Paediatric Gastroenterology, Hepatology and Nutrition guidelines for diagnosing celiac disease 2020","volume":"70","author":"Husby","year":"2020","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1111\/apt.12970","article-title":"The presence of anti-endomysial antibodies and the level of anti-tissue transglutaminases can be used to diagnose adult celiac disease without duodenal biopsy","volume":"40","author":"Tortora","year":"2014","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2433","DOI":"10.1007\/s10620-017-4672-1","article-title":"Application of the biopsy-sparing ESPGHAN guidelines for celiac disease diagnosis in adults: A real-life study","volume":"62","author":"Efthymakis","year":"2017","journal-title":"Dig. Dis. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1111\/apt.15109","article-title":"Serology-based criteria for adult celiac disease have excellent accuracy across the range of pre-test probabilities","volume":"49","author":"Fuchs","year":"2019","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1053\/j.gastro.2017.06.002","article-title":"Accuracy in diagnosis of celiac disease without biopsies in clinical practice","volume":"153","author":"Werkstetter","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Kauma, S., Kaukinen, K., Huhtala, H., Kivel\u00e4, L., Pekki, H., Salmi, T., Saavalainen, P., Lindfors, K., and Kurppa, K. (2019). The phenotype of celiac disease has low concordance between siblings, despite a similar distribution of HLA haplotypes. Nutrients, 25.","DOI":"10.3390\/nu11020479"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1136\/gut.35.6.776","article-title":"Endomysium antibodies in celiac disease: An improved method","volume":"35","author":"Ladinser","year":"1994","journal-title":"Gut"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1053\/j.gastro.2008.11.040","article-title":"Diagnosing mild enteropathy celiac disease: A randomized, controlled clinical study","volume":"136","author":"Kurppa","year":"2009","journal-title":"Gastroenterology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/0016-5085(92)91819-P","article-title":"Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (\u2018celiac sprue\u2019)","volume":"102","author":"Marsh","year":"1992","journal-title":"Gastroenterology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1111\/j.1572-0241.2003.07456.x","article-title":"Intraepithelial lymphocytes in celiac disease","volume":"98","author":"Kaukinen","year":"2003","journal-title":"Am. J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1080\/00365520510023422","article-title":"Small-bowel mucosal transglutaminase 2-specific IgA deposits in coeliac disease without villous atrophy: A prospective and randomized clinical study","volume":"40","author":"Kaukinen","year":"2005","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"387","DOI":"10.3109\/00365521.2014.974204","article-title":"Celiac disease evolving into dermatitis herpetiformis in patients adhering to normal or gluten-free diet","volume":"50","author":"Salmi","year":"2015","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1097\/MPG.0b013e318279887b","article-title":"Celiac disease: The new proposed ESPGHAN diagnostic criteria do work well in a selected population","volume":"56","author":"Klapp","year":"2013","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4399","DOI":"10.3748\/wjg.v18.i32.4399","article-title":"Tissue transglutaminase levels above 100 U\/mL and celiac disease: A prospective study","volume":"28","author":"Mubarak","year":"2012","journal-title":"World J. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1053\/j.gastro.2017.04.023","article-title":"Validation of antibody-based strategies for diagnosis of pediatric celiac disease without biopsy","volume":"153","author":"Wolf","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Popp, A., Arvola, T., Taavela, J., Kivel\u00e4, L., Ene, A., Laurila, K., Saavalainen, P., M\u00e4ki, M., and Kurppa, K. (2020). Nonbiopsy approach for celiac disease is accurate when using exact duodenal histomorphometry: Prospective study in 2 countries. J. Clin. Gastroenterol.","DOI":"10.1097\/MCG.0000000000001349"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1097\/MEG.0000000000000841","article-title":"Coeliac disease: Further evidence that biopsy is not always necessary for diagnosis","volume":"29","author":"Holmes","year":"2017","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.dld.2011.10.013","article-title":"High tissue-transglutaminase antibody level predicts small intestinal villous atrophy in adult patients at high risk of celiac disease","volume":"44","author":"Zanini","year":"2012","journal-title":"Dig. Liver Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1111\/cei.12249","article-title":"High-titre circulating tissue transglutaminase-2 antibodies predict small bowel villous atrophy, but decision cut-off limits must be locally validated","volume":"176","author":"Beltran","year":"2014","journal-title":"Clin. Exp. Immunol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1097\/MPG.0000000000002711","article-title":"Automated analyzers are suited for diagnosing celiac disease without a biopsy","volume":"71","author":"Rozenberg","year":"2020","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1038\/ajg.2015.285","article-title":"Are ESPGHAN \u201cBiopsy-Sparing\u201d guidelines for celiac disease also suitable for asymptomatic patients?","volume":"110","author":"Trovato","year":"2015","journal-title":"Am. J. Gastroenterol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/s10620-016-4354-4","article-title":"Tissue transglutaminase levels are not sufficient to diagnose celiac disease in North American practices without intestinal biopsies","volume":"62","author":"Elitsur","year":"2017","journal-title":"Dig. Dis. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.cgh.2012.09.027","article-title":"Celiac disease with mild enteropathy is not mild disease","volume":"11","author":"Zanini","year":"2013","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/j.crohns.2012.01.016","article-title":"Are positive serum-IgA-tissue-transglutaminase antibodies enough to diagnose coeliac disease without a small bowel biopsy? Post-test probability of coeliac disease","volume":"6","author":"Alsina","year":"2012","journal-title":"J. Crohns Colitis"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1038\/ajg.2017.480","article-title":"Measuring change in small intestinal histology in patients with celiac disease","volume":"113","author":"Adelman","year":"2018","journal-title":"Am. J. Gastroenterol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1542\/peds.2014-3675","article-title":"Clinical features of celiac disease: A prospective birth cohort","volume":"135","author":"Agardh","year":"2015","journal-title":"Pediatrics"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.jpeds.2016.12.077","article-title":"At-risk screened children with celiac disease are comparable in disease severity and dietary adherence to those found because of clinical suspicion: A large cohort study","volume":"183","author":"Kaukinen","year":"2017","journal-title":"J. Pediatr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.cgh.2012.09.030","article-title":"Degree of damage to the small bowel and serum antibody titers correlate with clinical presentation of patients with celiac disease","volume":"11","author":"Taavela","year":"2013","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1097\/MPG.0000000000001757","article-title":"Evidence supporting serology-based pathway for diagnosing celiac disease in asymptomatic children from high-risk groups","volume":"66","author":"Paul","year":"2018","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.dld.2019.11.011","article-title":"Prevalence and diagnostic outcomes of children with duodenal lesions and negative celiac serology","volume":"52","author":"Gustafsson","year":"2020","journal-title":"Dig. Liver Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1097\/MPG.0b013e31826531f6","article-title":"ESPGHAN guidance on coeliac disease 2012: Multiples of ULN for decision making do not harmonise assay performance across centres","volume":"55","author":"Egner","year":"2012","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_36","unstructured":"Celiac Disease (2020, June 02). Current Care Guidelines. Available online: www.kaypahoito.fi."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/12\/9\/2736\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:07:55Z","timestamp":1760177275000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/12\/9\/2736"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,8]]},"references-count":36,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,9]]}},"alternative-id":["nu12092736"],"URL":"https:\/\/doi.org\/10.3390\/nu12092736","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,8]]}}}