Journal Article

OC18 Is it safe to diagnose coeliac disease using the no-biopsy pathway for those with TGA-IgA ≥5x upper limit of normal: a regional study from Southwest England?

Zurick, N, Khattak, H, Basude, D, Gangalam, V, Knight, C, Paul, S, Tashtoush, L, Broad, S

2023

Overview

IntroductionThe ESPGHAN 2020 guidelines have streamlined the diagnostic pathways for paediatric coeliac disease [CD] and have recommended that all children with TGA-IgA ≥10xULN can be safely diagnosed via the no-biopsy pathway [NBP].1 During the COVID-19 pandemic there has been greater emphasis on the use of the NBP for lower TGA-IgA titres than that recommended by the ESPGHAN for diagnosing CD across the world including the UK.2 This practice has been supported by papers published from tertiary gastroenterology centres in Italy, India and England where a cut-off value of TGA ≥5xULN have been deemed to be safe for NBP.3–5 An English study published in 2017 have highlighted the variation in the TGA-IgA titres used across the centres in the UK including southwest England where the titre varied from 4 IU/ml to 30 IU/ml.6AimsTo establish whether the lower TGA-IgA ≥5xULN can be safely used for diagnosing CD via NBP across various TGA-IgA titres used in the non-specialist regional centres in the Southwest England [SWE].MethodsAnonymous data between 2013 and 2020 were obtained from 5 regional centres across the SWE for the patients with TGA-IgA between ≥5xULN and <10xULN at the time of referral and as to whether they were finally diagnosed with CD following upper GI endoscopy and histology. Data was also collected on the age of the patients at first TGA-IgA titres, sex, symptoms and other high risk factors e.g. Type-1 diabetes mellitus, first degree relatives.ResultsFive centres participated in the study. A total of 8 TGA-IgA titres have been used with values varying between 4 IU/ml to 30 CU/ml. 67 patients were identified and 48 underwent UGIE and biopsies, 45/48 (93.75%) got confirmation for CD on histology. The 3 who did not have confirmatory histology had repeat TGA-IgA <5xULN at the time of endoscopy. Out of rest 19, 13 were diagnosed via NBP and rest 6 did not undergo a formal diagnostic process to confirm or rule out CD. There were 44 females and 23 males; mean age was 10.1 years [range 2 – 17 years]. Out of 67 children, 5 had family history, 4 had type 1 diabetes, 1 each had auto-immune condition and Down’s syndrome, rest 8 had no documented indication for undergoing a screening for CD. Figure 1 shows the breakdown for the 5 centres and their conversion for diagnosed CD.ConclusionsThis 5 centre study shows 93.75% correlation of TGA-IgA 5–10xULN at referral to final diagnosis of CD despite 8 variations in assay methods. This appears to improve to 100% when repeated at time of endoscopy. 19.4% of this group were given a diagnosis of CD via NBP based on clinician’s decision. There is need for similar collaborative studies through the BSPGHAN PeGHAN network to firmly establish similar findings for various TGA-IgA titres used across the UK.Abstract OC18 Figure 1References Husby, et al. J Pediatr Gastroenterol Nutr. 2020;70(1):141–156. Ruan, et al. Gastroenterology. 2020;159(4):1547–1550. Bhattacharya, et al. Indian J Gastroenterol. 2014;33(4):350–4. Trovato, et al. Eur J Gastroenterol Hepatol. 2020;32(12):1523–1526. Paul, et al. Arch Dis Child. 2022;107(8):747–751. Paul, et al. Arch Dis Child. 2017;102(10):942–946.

• Publisher: BMJ Publishing Group LTD
• Subject: Biopsy / Celiac disease / Diabetes / Endoscopy / Gastroenterology / Histology