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

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


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 languageEnglish
Pages (from-to)97-102
Number of pages6
JournalFrontline Gastroenterology
Issue number2
Early online date11 Aug 2022
Publication statusPublished - 8 Feb 2023



ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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