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Coeliac disease
Original research
Serological screening for coeliac disease in an adult general population: the HUNT study
  1. Ina Lervåg Andersen1,2,
  2. Polina Lukina1,
  3. Ole T Dyrli1,
  4. Rolf Anton Klaasen3,
  5. David John Warren3,
  6. Nils Bolstad3,
  7. Patricia Mjønes4,5,
  8. Elin Rønne4,
  9. Rasmus Iversen6,
  10. Ludvig M Sollid6,7,
  11. Knut E A Lundin6,8,
  12. Eivind Ness-Jensen1,2,9,10
  1. 1 HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway
  2. 2 Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
  3. 3 Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
  4. 4 Department of Pathology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
  5. 5 Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
  6. 6 Norwegian Coeliac Disease Research Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  7. 7 Department of Immunology, Oslo University Hospital, Oslo, Norway
  8. 8 Department of Gastroenterology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
  9. 9 HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
  10. 10 Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Ina Lervåg Andersen; ina.l.andersen{at}ntnu.no

Abstract

Background A large proportion of individuals with coeliac disease (CeD) remain undiagnosed.

Objective The aim of this study was to assess serological screening for CeD in the adult general population.

Design The study was based on the fourth Trøndelag Health Study, a population-based study performed 2017–2019 in Nord-Trøndelag County, Norway, including 56 042 participants >20 years of age (54% participation rate). Serum samples were analysed with a dual antitransglutaminase 2 (TG2) IgA and IgG assay and seropositive participants were invited to endoscopy with duodenal biopsies. A CeD diagnosis was given if mucosal damage (Marsh grade 3) was found.

Results Histological evaluation of 657 seropositive participants confirmed CeD in 423. The positive predictive value (PPV) of a positive TG2 IgA was 73.3% (95% CI 69.7% to 77.0%) for biopsy-confirmed CeD. TG2 IgA ≥10 times the upper limit of normal (ULN), as used in the no-biopsy approach in children, increased the PPV to 88.1% (95% CI 84.8% to 91.4%). Primary TG2 IgG response was found in 87 participants, five of whom had biopsy-confirmed CeD. One of the participants with CeD primarily responding with TG2 IgG was IgA deficient. The PPV of a positive TG2 IgG was 5.8% (95% CI 1.9% to 12.9%) and of TG2 IgG ≥10× ULN was 9.5% (95% CI 1.2% to 30.4%) for biopsy-confirmed CeD in TG2 IgA-negative individuals.

Conclusion The TG2 IgA assay showed excellent abilities as a screening tool for CeD in the adult general population. However, the diagnostic accuracy of TG2 IgG was too poor for selectively identifying individuals with CeD.

  • COELIAC DISEASE
  • SMALL INTESTINAL BIOPSY
  • SCREENING

Data availability statement

Data are available upon reasonable request. Researchers with a PhD associated with Norwegian research institutes can apply for the use of HUNT material: data and samples - given approval by a Regional Committee for Medical and Health Research Ethics. Researchers from other countries are welcome to apply in cooperation with a Norwegian Principle Investigator. Access to the requested HUNT material is given after the application is approved of by HUNTs Data Access Committee (DAC) and an agreement is signed. The agreement gives the researcher(s) the right to research a specific topic for a limited time period and to publish a decided upon number of articles. For data information contact: HUNT Research Centre Forskningsveien 27600 Levanger, Norway. Phone +47 74 07 51 80 | +47 74 01 92 40 | +47 407 90 010. Mail: kontakt@hunt.ntnu.no

https://doi.org/10.1136/gutjnl-2024-333886

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    Data availability statement

    Data are available upon reasonable request. Researchers with a PhD associated with Norwegian research institutes can apply for the use of HUNT material: data and samples - given approval by a Regional Committee for Medical and Health Research Ethics. Researchers from other countries are welcome to apply in cooperation with a Norwegian Principle Investigator. Access to the requested HUNT material is given after the application is approved of by HUNTs Data Access Committee (DAC) and an agreement is signed. The agreement gives the researcher(s) the right to research a specific topic for a limited time period and to publish a decided upon number of articles. For data information contact: HUNT Research Centre Forskningsveien 27600 Levanger, Norway. Phone +47 74 07 51 80 | +47 74 01 92 40 | +47 407 90 010. Mail: kontakt@hunt.ntnu.no

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    Footnotes

    • X @Huldra_78

    • Contributors Guarantor: ILA. Validation, data curation, formal analysis, software, visualisation, writing – original draft: ILA. Conceptualisation, methodology: ILA, EN-J, LMS and KEAL. Funding acquisition, project administration, resources: EN-J. Investigation: ILA and EN-J. Supervision: EN-J and KEAL. Writing – review and editing: all authors.

    • Funding This study was funded by Norway celiac foundation (Norsk cøliakiforening), Liaison Committee for Education, Research and Innovation in Central Norway (Samarbeidsorganet), The research council of Norway (Forskningsrådet).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.