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

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

N1 - Copyright: © 2022 Author(s) (or their employer(s)). No commercial re-use. See rights and permissions. Published by BMJ.

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.

KW - COELIAC DISEASE

UR - https://www.scopus.com/pages/publications/85136492356

U2 - 10.1136/flgastro-2022-102254

DO - 10.1136/flgastro-2022-102254

M3 - Article

C2 - 36818788

AN - SCOPUS:85136492356

SN - 2041-4137

VL - 14

SP - 97

EP - 102

JO - Frontline Gastroenterology

JF - Frontline Gastroenterology

IS - 2

ER -