Figure 5. The presented diagnostic algorhitm takes into account that extremely high anti-tTGase 2 IgA levels (reaching tenfold of the borderline value defined by Vermeersch et al. [61]) may confirm the diagnosis of CD without biopsy. In the case of medium and/or lower anti-tTGase 2 levels, duodenal biopsy should be taken to confirm the results of serology. The serology is a prior (first) choice in children and in adults, whose clinical symptoms are neither typical nor relevant. Even if the serological markers cannot be regarded in CD diagnostic for absolutely superseding, their advantage is in simplicity, high specificity and in noninvasive way of sampling. In cases showing typical symptoms, vice versa, the serology is at second line of choice, especially important for confirming the diagnosis in cases of uncertain biopsy results. Finally, for the therapeutic strategy when serology is positive, but histology negative, an assessment of inherited risk by HLA II DQ genotyping seems inevitable. : The Malabsorption Syndrome versus Celiac Disease: A Diagnostic Reappraisal : Science and Education Publishing

Figure 5. The presented diagnostic algorhitm takes into account that extremely high anti-tTGase 2 IgA levels (reaching tenfold of the borderline value defined by Vermeersch et al. [61]) may confirm the diagnosis of CD without biopsy. In the case of medium and/or lower anti-tTGase 2 levels, duodenal biopsy should be taken to confirm the results of serology. The serology is a prior (first) choice in children and in adults, whose clinical symptoms are neither typical nor relevant. Even if the serological markers cannot be regarded in CD diagnostic for absolutely superseding, their advantage is in simplicity, high specificity and in noninvasive way of sampling. In cases showing typical symptoms, vice versa, the serology is at second line of choice, especially important for confirming the diagnosis in cases of uncertain biopsy results. Finally, for the therapeutic strategy when serology is positive, but histology negative, an assessment of inherited risk by HLA II DQ genotyping seems inevitable.

International Journal of Celiac Disease. 2015, 3(4), 118-131 doi:10.12691/ijcd-3-4-5