Year: 2019
Type: conference-paper
Study design: Observational Study
Abstract: Introduction National Institute of Clinical Excellance (NICE) and British Society of Gastroenterology (BSG) guidelines advise that a Duodenal ( D2) Biopsy is required for a definitive diagnosis of coeliac disease. British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) 2013 guidelines indicate that this may not always be necessary. This study explored whether D2 Biopsy needs to be mandatory in the event of strongly positive IgA tissue transglutaminase (tTG). Methods We extracted data from the pathology system for all adult patients who tested positive for IgA tTG between January to December 2018. For IgG and IgA tTG a fluorescent enzyme immunoassay technique is used ( Reagents from ThermoFisher on Phadia 250 analyser) by our local laboratory. tTG is reported as numeric value. Patients without D2 biopsies or biopsies more than 3 months apart from serology (n= 147) and patients already known to have coeliac disease (n=9) were excluded. D2 biopsy results were reviewed for all included patients. Marsh classification was applied to interpret the biopsy results. We then verified different multiples of Upper Limits of Normal (ULN) IgA tTG against the D2 biopsy results. Results The total number of adult patients who had positive serology in the study period was 214. After applying the exclusion criteria, D2 biopsies of 58 patients were studied. The age range was 17 to 89 (mean 53.46, median 57). Male female ratio was 23:35. 47 of these patients had positive D2 biopsies (Marsh 2 or above), 3 patients had biopsies consistent with Marsh 1. Positive Predictive Value (PPV) for positive tTG taking different multiples of ULN was as follows. Conclusions The current Gold standard for diagnosis of Coeliac disease is a positive D2 biopsy. This initial study shows that locally agreed cut off for positive serology can be accepted as diagnostic and the need for OGD and D2 biopsies could be avoided. Potentially this could reduce delays in diagnosis and allow patients to commence a gluten free diet more quickly.
Source: Gut
Authors: Ravi Ranjan, Helen Dallal, Cristina Dragos, Jodi Gaston-Ross
Institution: South Tees Hospitals NHS Foundation Trust
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3020822200