Background The coeliac disease (CD) guidelines were updated by ESPGHAN in 2020 confirming that children (0–16yrs) with TGA-IgA titres ≥10x upper limit of normal (≥10xULN) and positive EMA result can safely be diagnosed with CD via the no-biopsy pathway (NBP). This practice is well adopted in the UK and has led to prompt diagnosis, reduction of the burden on endoscopy services and significant cost saving to the NHS. The COVID-19 pandemic has led to unprecedented challenges for the health service especially endoscopy services. We rarely observed non-diagnostic histopathology TGA-IgA ≥5x ULN in our unit which receives referrals from whole of Southwest England.

Aims To explore the relationship of TGA-IgA ≥5x ULN with histological diagnosis of CD in children referred to a single large tertiary centre.

Methods Prospectively recorded data for children diagnosed with CD following endoscopy over 14-year period (September 2006 to August 2020) was analysed. The data included age, sex, reason for screening, indication for endoscopy, TGA-IgA levels at endoscopy, and histological findings. Where quantitative TGA-IgA was unavailable or not recorded were excluded from the analysis. Statistical analysis was performed using χ2 analysis and p<0.05 was considered significant.

Results 947 children had endoscopy, but 871 had complete data and were included in final analysis. 772/871 received a histological confirmation of CD by Marsh-Oberhuber histological grading (MO-HG) 2 to 3c. 441 had TGA-IgA ≥5x and 439 (99.5%) had a positive histological diagnosis. The likelihood of a positive biopsy with TGA-IgA ≥5x titre (439/441) compared to TGA-IgA <5 ULN titre (333/430) has strong statistical significance (p<0.00001). Two children of 441 who had MO-HG <2 actually had TGA-IgA >10 ULN. The mean and median ages of the patients with confirmed CD (n=772) was 8.68 years and 9.1 years respectively (range 0–17 years), with a male to female ratio ≈ 1:2. Figure 1 shows the outcome of the 947 children who had endoscopy.

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Abstract O8 Figure 1

Flow chart showing TTG-IgA and histological correlation for children with suspected CD.CD, celiac disease; GFD, gluten free diet; MO-HG, Marsh Oberhuber histological grading; TTG-IgA, IgA-based anti-tissue transglutaminase antibody; UGIE, upper gastrointestinal endoscopy; ULN, upper limit of normal

Conclusion This study showed that 99.5% of children with TGA-IgA ≥5xULN had clear histological confirmation of CD with p<0.00001 compared to TGA-IgA<5xULN. For the same advantages of the current NBP and considering the challenges posed by the COVID-19 pandemic, changing the guidance to TGA-IgA ≥5xULN appears to be safe and secure for diagnosis of CD in children.