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Original research
No-biopsy strategy for coeliac disease is applicable in adult patients: a ‘real-world’ Scottish experience
  1. Aoisha Hoyle1,
  2. Peter Gillett2,
  3. Helen R Gillett3,
  4. Reuben Borg1,
  5. Steven Nottley1,
  6. Samantha Farrow3,
  7. Maha Elgoweini4,
  8. Mohamed Elhassan4,
  9. Jonathan Fletcher5,
  10. Gemma Whannel6,
  11. Edel Gracie6,
  12. Sarah Morgan7,
  13. Hasnain Jafferbhoy7,
  14. Laura Dunbar8,
  15. Gordon Reid8,
  16. Emma L Metcalfe9,
  17. Graeme Smith10,
  18. Sarah Harris10,
  19. Calum Robertson10,
  20. Moira Thomas11,
  21. Hazel Younger12,
  22. Elizabeth Furrie13
  1. 1Department of Pathology, University Hospital Monklands, NHS Lanarkshire, Airdrie, UK
  2. 2Department of Paediatric Gastroenterology, Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, UK
  3. 3Department of Gastroenterology, St John's Hospital, NHS Lothian, Edinburgh, UK
  4. 4Department of Pathology, University Hospital Crosshouse, NHS Ayrshire and Arran, Ayr, UK
  5. 5Department of Gastroenterology, Borders General Hospital, NHS Borders, Melrose, UK
  6. 6Department of Gastroenterology, Dumfries and Galloway Royal Infirmary, NHS Dumfries and Galloway, Dumfries, UK
  7. 7Department of Gastroenterology, Victoria Hospital, NHS Fife, Kirkcaldy, UK
  8. 8Department of Pathology, Forth Valley Royal Hospital, NHS Forth Valley, Stirling, UK
  9. 9Department of Digestive Disorders, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
  10. 10Department of Pathology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
  11. 11Department of Immunology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
  12. 12Department of Gastroenterology, Raigmore Hospital, NHS Highland, Inverness, UK
  13. 13Department of Immunology Laboratory Services, Ninewells Hospital, NHS Tayside, Dundee, UK
  1. Correspondence to Dr Aoisha Hoyle, Department of Pathology, University Hospital Monklands, NHS Lanarkshire, Airdrie, ML6 0JS, UK; aoisha.hoyle{at}lanarkshire.scot.nhs.uk

Abstract

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.

  • COELIAC DISEASE

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors AH, PG and SH: project concept. AH and PG equally prepared, revised and edited the manuscript with comments and review from all authors. AH: author acting as guarantor.

  • 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.

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

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