Introduction The no-biopsy pathway [NBP] has been successfully being used for diagnosing coeliac disease [CD] in children since 2012. However, the need for upper GI endoscopy and biopsy has remained an essential step for diagnosing CD in adults and there has been reluctance amongst the adult gastroenterologists to adopt the NBP for diagnosing CD in adults. During the COVID-19 pandemic, the British Society of Gastroenterology (BSG) published interim guidelines for diagnosing CD, including the NBP for those under 55 years and with no other concerning features.¹

Aims To establish, by analysis of published articles and abstracts, whether the ESPGHAN recommended NBP is a safe approach to the diagnosis of CD in adult practice

Methods We included UK-based prospective and retrospective studies identified in a search of PubMed, Google Scholar, EmBase, databases with the terms: adults, CD, NBP, ESPGHAN guidelines, BSG.

Results A total of 5 publications^2–6 were identified from the UK: 4 papers and 1 abstract. A total of 728 patients with anti-tissue transglutaminase antibody (TGA)-IgA values ≥10x Upper Limit of Normal (ULN) were identified from the 5 publications, 711/728 were confirmed to have CD following upper gastrointestinal endoscopy (UGIE) and biopsy with Marsh 2–3 identified on histology. Figure 1 shows the breakdown for the studies included in the analysis. 97.66% of patients with TGA-IgA ≥10xULN received histological confirmation of CD.

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Abstract OC57 Figure 1

Publications highlighting cases of CD for TGA-IgA ≥10xULN

Conclusions Our analysis of UK-based adult CD studies have shown that the NBP can be safely implemented in the UK, and supports the recommendations made in the BSG COVID-19 interim guidelines for CD. The NBP prevents unnecessary delay in the management of patients with CD. Studies from Italy, India, Finland and New Zealand alongside the UK-based data have shown that life-threatening concomitant pathologies are extremely rare in the adult CD population, and that a NBP is accurate and safe.^7–10 We hope the next revision of the NICE CD guidelines will acknowledge and include the NBP for diagnosis of CD which will streamline the diagnostic pathways across both paediatric and adult gastroenterology practice.

References

1. BSG (2020). COVID-19 Specific Interim Guidance on Biopsy in Adult Coeliac Disease. https://www.bsg.org.uk/covid-19-advice/covid-19-specific-non-biopsy-protocol-guidancefor-those-with-suspected-coeliac-disease

2. Johnston, et al. Frontline Gastroenterol. 2020;13(1):73–76.

3. Paul, et al. Aliment Pharmacol Ther. 2021;53(2):357–358.

4. Tashtoush, et al. Aliment Pharmacol Ther. 2021;54(8):1090–1092.

5. Penny, et al. Gut. 2021;70(5):876–883.

6. Wong, et al. PWE-116 Gut. 2012;61:A344.

7. Maimaris, et al. Eur J Gastroenterol Hepatol. 2020;32(11):1447–1451.

8. Beig, et al. Frontline Gastroenterol. 2021 Jun 25;13(4):287–294.

9. Fuchs, et al. Aliment Pharmacol Ther. 2019;49(3):277–284.

10. Bansal, et al. Indian J Clin Biochem. 2018;33(4):456–460.