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Letters
August 11, 2010

Diagnostic Testing for Celiac Disease

JAMA. 2010;304(6):639-640. doi:10.1001/jama.2010.1109

To the Editor: In their systematic review, Dr van der Windt and colleagues1 evaluated the performance of diagnostic tests for identifying celiac disease among adult patients with abdominal symptoms. In our opinion, the rigorous clinical criteria adopted by the authors to select eligible literature contributions were not used when evaluating the diagnostic efficiency and effectiveness of serum tests adopted in the analyzed studies. This is particularly true for IgA antitissue transglutaminase antibodies (IgA-tTG), which can be prepared using either guinea pig (gptTG) or human (htTG) antigens. Assays that use gptTG provide results with lower sensitivity and specificity than htTG2,3 and are often considered obsolete first-generation methods.

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