Simple blood test could be used to diagnose coeliac disease in adults

A simple blood test could be used to diagnose coeliac disease in adults, eliminating the need for more invasive procedures, a study has found.

Coeliac disease is where a person’s immune response to gluten attacks the tissues in their digestive system.

While a blood test is used to diagnose the disease in children, adults commonly undergo endoscopy and biopsy before being diagnosed.

Research carried out at Mater Dei Hospital found that doctors were able to accurately identify most adult patients with the disease through a blood test, especially when certain antibody levels were very high.

This approach, already used in children, provides more evidence to a non-biopsy approach in specific circumstances. 

The peer-reviewed publication was authored by Suzanne Cauchi, Abigail Pace, Martina Sciberras and Pierre Ellul. Titled ‘Beyond biopsy: evaluating noninvasive techniques to diagnose coeliac disease in adults,’ it was recently published in the international open-access journal Annals of Gastroenterology.

Coeliac disease is an autoimmune condition which occurs due to genetic and environmental factors. Gluten – found in wheat, barley and rye – causes the immune system to damage the small intestine. This can lead to symptoms like bloating, diarrhoea, fatigue and osteoporosis.

Left untreated, coeliac disease can cause serious complications, but early diagnosis and a strict gluten-free diet can lead to full recovery and prevent long-term health problems, explained Sciberras, a consultant in gastroenterology and internal medicine

According to the research paper, current international rules say that after a positive blood test for coeliac disease, a tissue sample (biopsy) from the small intestine is needed to confirm the diagnosis. This biopsy method is invasive and has some problems because the changes in the tissue can be unclear or uneven.

In 2020, the European Society for Paediatric Gastroenterology and Nutrition updated their guidelines for children and teenagers. They said it is safe to diagnose coeliac disease without a biopsy if the blood test for a specific antibody is very high (at least 10 times the normal limit) and if another antibody test is also positive in a second blood sample.

Coeliac disease cases increased

The study looked back at 114 patients to see if the same non-biopsy method could be used to diagnose coeliac in adults and concluded this was the case in many patients.

Sciberras noted that, according to research published during the 2024 International Coeliac Disease Symposium held in Sheffield, over the past decade, the number of people diagnosed with coeliac disease in Malta has seen a sharp rise.

“In 2013, 46 new cases were identified, while in 2023, this number had grown to 125 – an increase of 171%. Most of the cases (over 72%) were in adults aged 18 and over, and women were found to be more than twice as likely as men to be diagnosed,” she said.

This increase highlights greater awareness, improved testing, and possibly a real rise in the number of people affected by the condition, according to Sciberras.

She added that she, together with Ellul – through the University of Malta’s Department of Gastroenterology and Immunology – were carrying out further research into how common the condition is in asymptomatic people. The research also involves studying the gut bacteria (microbiota) of newly diagnosed coeliac patients and comparing it to samples taken after starting a gluten-free diet.

“This will help researchers explore whether changes in gut bacteria could be another environmental factor linked to the development of coeliac disease,” she said.

To mark Coeliac Awareness Month, the Malta Association of Gastroenterology, with the help of Mater Dei Hospital, recently organised two special events focused on understanding and managing coeliac disease. ‘Thriving Gluten-Free’ was a patient-focused event that featured expert talks from dieticians and gastroenterologists.

Another seminar was tailored for doctors and healthcare professionals, focusing on the latest developments in the management of the disease. Carolina Ciacci, a full professor of gastroenterology at the University of Salerno in Italy, was invited as a guest speaker.