No-biopsy strategy for coeliac disease is applicable in adult patients: a 'real-world' Scottish experience

Aoisha Hoyle; Peter Gillett; Helen R. Gillett; Reuben Borg; Steven Nottley; Samantha Farrow; Maha Elgoweini; Mohamed Elhassan; Jonathan Fletcher; Gemma Whannel; Edel Gracie; Sarah Morgan; Hasnain Jafferbhoy; Laura Dunbar; Gordon Reid; Emma L. Metcalfe; Graeme Smith; Sarah Harris; Calum Robertson; Moira Thomas; Hazel Younger; Elizabeth Furrie

doi:10.1136/flgastro-2022-102254

No-biopsy strategy for coeliac disease is applicable in adult patients: a 'real-world' Scottish experience

Aoisha Hoyle (Lead / Corresponding author), Peter Gillett, Helen R. Gillett, Reuben Borg, Steven Nottley, Samantha Farrow, Maha Elgoweini, Mohamed Elhassan, Jonathan Fletcher, Gemma Whannel, Edel Gracie, Sarah Morgan, Hasnain Jafferbhoy, Laura Dunbar, Gordon Reid, Emma L. Metcalfe, Graeme Smith, Sarah Harris, Calum Robertson, Moira ThomasHazel Younger, Elizabeth Furrie

Undergraduate Medicine

Research output: Contribution to journal › Article › peer-review

14 Citations (Scopus)

Abstract

Objective: Emergency interim guidance from the British Society for Gastroenterology (BSG) states that a no-biopsy strategy is possible to diagnose coeliac disease (CD) in adults with elevated transglutaminase IgA antibody (TGA-IgA) levels. We aimed to determine if the suggested TGA-IgA ≥10× ULN is safe and robust in making the diagnosis in adult patients in Scotland. We also aimed to establish if any important co-diagnoses would be missed if no biopsy was performed.

Method: All positive coeliac serology results for patients aged >15 years in Scotland in 2016 (Grampian 2019) were accessed. Data were collected on demographics, TGA-IgA titres, D1 sampling, histology and macroscopic findings at upper and lower gastrointestinal (GI) endoscopy.

Results: 1037/1429 patients with positive serology proceeded to biopsy, of which 796/1037 (76.8%) were diagnosed as CD. A total of 320/322 (99.37%) patients with TGA-IgA ≥10× ULN were diagnosed as CD giving the cut-off a positive predictive value of 99.38%. No significant co-pathology was found at endoscopy in these patients.

Conclusion: Our results show that a no-biopsy strategy using a cut-off of TGA-IgA ≥10× ULN is safe to diagnose CD and that no important pathology would be missed. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition 2020 and BSG COVID-19 interim guidelines are applicable to adult patients in Scotland.

Original language	English
Pages (from-to)	97-102
Number of pages	6
Journal	Frontline Gastroenterology
Volume	14
Issue number	2
Early online date	11 Aug 2022
DOIs	https://doi.org/10.1136/flgastro-2022-102254
Publication status	Published - 8 Feb 2023

Keywords

COELIAC DISEASE

ASJC Scopus subject areas

Hepatology
Gastroenterology

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10.1136/flgastro-2022-102254

Cite this

Hoyle, A., Gillett, P., Gillett, H. R., Borg, R., Nottley, S., Farrow, S., Elgoweini, M., Elhassan, M., Fletcher, J., Whannel, G., Gracie, E., Morgan, S., Jafferbhoy, H., Dunbar, L., Reid, G., Metcalfe, E. L., Smith, G., Harris, S., Robertson, C., ... Furrie, E. (2023). No-biopsy strategy for coeliac disease is applicable in adult patients: a 'real-world' Scottish experience. Frontline Gastroenterology, 14(2), 97-102. https://doi.org/10.1136/flgastro-2022-102254

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title = "No-biopsy strategy for coeliac disease is applicable in adult patients: a 'real-world' Scottish experience",

abstract = "Objective: Emergency interim guidance from the British Society for Gastroenterology (BSG) states that a no-biopsy strategy is possible to diagnose coeliac disease (CD) in adults with elevated transglutaminase IgA antibody (TGA-IgA) levels. We aimed to determine if the suggested TGA-IgA ≥10× ULN is safe and robust in making the diagnosis in adult patients in Scotland. We also aimed to establish if any important co-diagnoses would be missed if no biopsy was performed.Method: All positive coeliac serology results for patients aged >15 years in Scotland in 2016 (Grampian 2019) were accessed. Data were collected on demographics, TGA-IgA titres, D1 sampling, histology and macroscopic findings at upper and lower gastrointestinal (GI) endoscopy.Results: 1037/1429 patients with positive serology proceeded to biopsy, of which 796/1037 (76.8%) were diagnosed as CD. A total of 320/322 (99.37%) patients with TGA-IgA ≥10× ULN were diagnosed as CD giving the cut-off a positive predictive value of 99.38%. No significant co-pathology was found at endoscopy in these patients.Conclusion: Our results show that a no-biopsy strategy using a cut-off of TGA-IgA ≥10× ULN is safe to diagnose CD and that no important pathology would be missed. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition 2020 and BSG COVID-19 interim guidelines are applicable to adult patients in Scotland.",

keywords = "COELIAC DISEASE",

author = "Aoisha Hoyle and Peter Gillett and Gillett, {Helen R.} and Reuben Borg and Steven Nottley and Samantha Farrow and Maha Elgoweini and Mohamed Elhassan and Jonathan Fletcher and Gemma Whannel and Edel Gracie and Sarah Morgan and Hasnain Jafferbhoy and Laura Dunbar and Gordon Reid and Metcalfe, {Emma L.} and Graeme Smith and Sarah Harris and Calum Robertson and Moira Thomas and Hazel Younger and Elizabeth Furrie",

note = "Copyright: {\textcopyright} 2022 Author(s) (or their employer(s)). No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2023",

month = feb,

day = "8",

doi = "10.1136/flgastro-2022-102254",

language = "English",

volume = "14",

pages = "97--102",

journal = "Frontline Gastroenterology",

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Hoyle, A, Gillett, P, Gillett, HR, Borg, R, Nottley, S, Farrow, S, Elgoweini, M, Elhassan, M, Fletcher, J, Whannel, G, Gracie, E, Morgan, S, Jafferbhoy, H, Dunbar, L, Reid, G, Metcalfe, EL, Smith, G, Harris, S, Robertson, C, Thomas, M, Younger, H & Furrie, E 2023, 'No-biopsy strategy for coeliac disease is applicable in adult patients: a 'real-world' Scottish experience', Frontline Gastroenterology, vol. 14, no. 2, pp. 97-102. https://doi.org/10.1136/flgastro-2022-102254

TY - JOUR

T1 - No-biopsy strategy for coeliac disease is applicable in adult patients

T2 - a 'real-world' Scottish experience

AU - Hoyle, Aoisha

AU - Gillett, Peter

AU - Gillett, Helen R.

AU - Borg, Reuben

AU - Nottley, Steven

AU - Farrow, Samantha

AU - Elgoweini, Maha

AU - Elhassan, Mohamed

AU - Fletcher, Jonathan

AU - Whannel, Gemma

AU - Gracie, Edel

AU - Morgan, Sarah

AU - Jafferbhoy, Hasnain

AU - Dunbar, Laura

AU - Reid, Gordon

AU - Metcalfe, Emma L.

AU - Smith, Graeme

AU - Harris, Sarah

AU - Robertson, Calum

AU - Thomas, Moira

AU - Younger, Hazel

AU - Furrie, Elizabeth

PY - 2023/2/8

Y1 - 2023/2/8

N2 - Objective: Emergency interim guidance from the British Society for Gastroenterology (BSG) states that a no-biopsy strategy is possible to diagnose coeliac disease (CD) in adults with elevated transglutaminase IgA antibody (TGA-IgA) levels. We aimed to determine if the suggested TGA-IgA ≥10× ULN is safe and robust in making the diagnosis in adult patients in Scotland. We also aimed to establish if any important co-diagnoses would be missed if no biopsy was performed.Method: All positive coeliac serology results for patients aged >15 years in Scotland in 2016 (Grampian 2019) were accessed. Data were collected on demographics, TGA-IgA titres, D1 sampling, histology and macroscopic findings at upper and lower gastrointestinal (GI) endoscopy.Results: 1037/1429 patients with positive serology proceeded to biopsy, of which 796/1037 (76.8%) were diagnosed as CD. A total of 320/322 (99.37%) patients with TGA-IgA ≥10× ULN were diagnosed as CD giving the cut-off a positive predictive value of 99.38%. No significant co-pathology was found at endoscopy in these patients.Conclusion: Our results show that a no-biopsy strategy using a cut-off of TGA-IgA ≥10× ULN is safe to diagnose CD and that no important pathology would be missed. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition 2020 and BSG COVID-19 interim guidelines are applicable to adult patients in Scotland.

AB - Objective: Emergency interim guidance from the British Society for Gastroenterology (BSG) states that a no-biopsy strategy is possible to diagnose coeliac disease (CD) in adults with elevated transglutaminase IgA antibody (TGA-IgA) levels. We aimed to determine if the suggested TGA-IgA ≥10× ULN is safe and robust in making the diagnosis in adult patients in Scotland. We also aimed to establish if any important co-diagnoses would be missed if no biopsy was performed.Method: All positive coeliac serology results for patients aged >15 years in Scotland in 2016 (Grampian 2019) were accessed. Data were collected on demographics, TGA-IgA titres, D1 sampling, histology and macroscopic findings at upper and lower gastrointestinal (GI) endoscopy.Results: 1037/1429 patients with positive serology proceeded to biopsy, of which 796/1037 (76.8%) were diagnosed as CD. A total of 320/322 (99.37%) patients with TGA-IgA ≥10× ULN were diagnosed as CD giving the cut-off a positive predictive value of 99.38%. No significant co-pathology was found at endoscopy in these patients.Conclusion: Our results show that a no-biopsy strategy using a cut-off of TGA-IgA ≥10× ULN is safe to diagnose CD and that no important pathology would be missed. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition 2020 and BSG COVID-19 interim guidelines are applicable to adult patients in Scotland.

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U2 - 10.1136/flgastro-2022-102254

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AN - SCOPUS:85136492356

SN - 2041-4137

VL - 14

SP - 97

EP - 102

JO - Frontline Gastroenterology

JF - Frontline Gastroenterology

IS - 2

ER -

No-biopsy strategy for coeliac disease is applicable in adult patients: a 'real-world' Scottish experience

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