PT  - JOURNAL ARTICLE
AU  - Richard David Johnston
AU  - Ying Jenny Chan
AU  - Tayyib Mubashar
AU  - Joseph Robert Bailey
AU  - Siba Prosad Paul
TI  - No-biopsy pathway following the interim BSG guidance reliably diagnoses adult coeliac disease
AID  - 10.1136/flgastro-2020-101624
DP  - 2022 Jan 01
TA  - Frontline Gastroenterology
PG  - 73--76
VI  - 13
IP  - 1
4099  - http://fg.bmj.com/content/13/1/73.short
4100  - http://fg.bmj.com/content/13/1/73.full
SO  - Frontline Gastroenterol2022 Jan 01; 13
AB  - 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.