key: cord-0685275-xlnoqm5k
authors: Tashtoush, Lina Bourhan; Bosanko, Nicholas Charles; Broad, Samuel Robin; Chan, Ying Jenny; Singhal, Natasha; Saji, Sharon; Saju, Nissy; Shah, Anusha; Zulfiqar, Ansab; Ilarionos, Melina; Paul, Siba Prosad
title: Letter: the BSG COVID‐19 interim coeliac disease guidance no‐biopsy approach is safe in adults
date: 2021-09-26
journal: Aliment Pharmacol Ther
DOI: 10.1111/apt.16553
sha: fd74f9dd3909b1dbaa7ff1f6fe903a6735303e65
doc_id: 685275
cord_uid: xlnoqm5k

This article is linked to Paul et al paper. To view this article, visit https://doi.org/10.1111/apt.16133

We read with interest the articles by Fuchs et al and Paul et al describing the validity of a no-biopsy pathway (NBP) for coeliac disease in adult patients with IgA-based anti-tissue transglutaminase (tTG-IgA) titres of ≥10-times upper limit of normal (ULN) whose duodenal biopsy had corroborating histological changes diagnostic of coeliac disease. 1,2 Interim COVID-19 British Society of Gastroenterology (BSG) guidance (reflecting long-established paediatric practice) advised an NBP for adults with tTG-IgA ≥10 × ULN and no other alarm symptoms (https://www.bsg.org.uk/covid -19-advic e/covid -19-speci fic-non-biops y-proto col-guida ncefo r-those -with-suspe cted-coeli acdisea se/). A retrospective case note audit study was done in 2021 to evaluate:

• The accuracy of NBP in adults with suspected coeliac disease There has been concern regarding omitting biopsy to diagnose adult coeliac disease due to worry about missing significant concomitant conditions, notably malignancy in the over 50s. However, a recent study from Italy reassuringly reported no such concerns. 3 One prospective and two retrospective studies from England evaluating the feasibility of an NBP in adults with tTG-IgA ≥10 × ULN, revealed no other co-existing organic pathologies, and definite histological correlation with coeliac disease was reported in >95% cases across all three studies. 2, 4, 5 Our study echoes the findings of two recently published English studies in which 33% and 17% patients, respectively, were not referred for gastroscopy following a positive coeliac serology. 4, 5 We provide further evidence that an NBP can be safely im- Local teams should monitor and manage the diagnostic pathways appropriately as a continuous audit. Worryingly, a third of tTG-IgA-positive patients were not referred. This is being increasingly identified and should be addressed as a potential reason for suboptimal diagnostic rates. 

Letter: no-biopsy pathway for diagnosing adult coeliac disease

Low prevalence of upper endoscopic gastrointestinal findings despite high frequency of alarm symptoms at the time of diagnosis in adult coeliac disease

Accuracy of a no-biopsy approach for the diagnosis of coeliac disease across different adult cohorts

A nobiopsy pathway following the interim BSG guidance reliably diagnoses adult coeliac disease in a UK district general hospital