TY - JOUR T1 - Highlights from this Issue JF - Frontline Gastroenterology JO - Frontline Gastroenterol SP - 91 LP - 92 DO - 10.1136/flgastro-2023-102398 VL - 14 IS - 2 AU - R Mark Beattie Y1 - 2023/03/01 UR - http://fg.bmj.com/content/14/2/91.abstract N2 - Previously the gold standard for the diagnosis of Coeliac Disease was small intestinal biopsy. The advent of increasingly robust serological testing has resulted in the development of ‘no-biopsy’ diagnostic algorithms led by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition. In summary (the detail is in the paper) if the TGA-IgA is>10 times the upper limit of normal then biopsy is not required. In this paper the authors test their ’real world’ experience in their 2016 cohort. Of 1429 patients with positive serology 1037 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. The authors rightly conclude that the no biopsy strategy used in children can be adopted in adults with the potential to improve time to diagnosis and reduce the endoscopy burden. There is an excellent accompanying commentary A no-biopsy approach to the diagnosis of coeliac disease (See page 97 … ER -