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No-biopsy pathway following the interim BSG guidance reliably diagnoses adult coeliac disease
  1. Richard David Johnston1,
  2. Ying Jenny Chan2,3,
  3. Tayyib Mubashar2,
  4. Joseph Robert Bailey4,
  5. Siba Prosad Paul2,5
  1. 1Gastroenterology, Torbay Hospital, Torquay, UK
  2. 2Paediatrics, Torbay Hospital, Torquay, UK
  3. 3Peninsula Medical School, University of Plymouth, Plymouth, UK
  4. 4Clinical Biochemistry, Torbay Hospital, Torquay, UK
  5. 5Paediatrics, Yeovil District Hospital, Yeovil, UK
  1. Correspondence to Dr Siba Prosad Paul, Torbay Hospital, Torquay, Devon, TQ2 7AA, UK; siba{at}


Recent interim guidance from the British Society of Gastroenterology, aligned to historical paediatric practice, advises a no-biopsy protocol (NBP) for adults with high anti-tissue transglutaminase (tTG-IgA) titres and other clinical factors. A 7-year retrospective review identified 433 patients with positive tTG-IgA. Of these 433, 98 (23%) fulfilled the high titre criteria for an NBP which may have reduced endoscopic burden on the service. A high titre versus low titre translated in a 95% versus 75% histological confirmation of coeliac disease (p<0.01). The addition of anti-endomysial antibody analyses impacted minimally on these predictive rates. Our data support an NBP approach for selected patients. Of concern, however, was the finding that a third of patients with positive titres were not referred for a biopsy despite national guidance at the time advocating it. A clear message needs to be transmitted that the NBP is only for those with high titre, as opposed to any tTG-IgA positivity.

  • coeliac disease
  • small intestinal biopsy

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  • Contributors RDJ and SPP: project concept, supervision, prepared, revised and edited the manuscript with comments and review from all authors. YJC, TM and JRB: generation of patient list through database search, collected and analysed data. All authors have approved the uploaded draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.