TBA (22W128)

Could recent guidelines on the ‘no biopsy’ approach to diagnosis of Paediatric Coeliac Disease be extrapolated to the adult population

Author(s)

M. Reidy, J. Hoban, E. O’Toole, S. Quinn

Department(s)/Institutions

Department of Paediatric Gastroenterology, Children’s Health Ireland (CHI), @ Tallaght Hospital, D24

Introduction

ESPGHAN/NASPGHAN’s 2020 guidelines redefined the Coeliac Disease (CD) diagnostic criteria in children. Recommendations include a ‘no biopsy’ approach in children with anti- tissue Transglutaminase (anti-tTg) IgA titres ≥x10 upper limits of normal (ULN) and positive anti-endomysial antibody IgA in a 2nd sample. Removal of the previously recommended HLA-based stratification (2012 guidelines) enabled application of the revised criteria to the Irish paediatric population.

Aims/Background

With implementation of the revised guidelines, we sought to determine the number of patients who could be diagnosed with CD without the need for biopsy at Children’s Health Ireland (CHI) at Tallaght, Dublin. 280 oesophagogastroduodenoscopies (OGDs) are delivered, by a singlehanded gastroenterologist, there annually, each requiring general anaesthetic. Children often wait many months for a biopsy-confirmed diagnosis.

Method

Retrospective study of all children (<16-years, n=83), diagnosed with biopsy-confirmed CD, in CHI, at Tallaght within a 24-month period (2017-2019). Data was sourced from paper charts, histology and endoscopy records and analysed on Excel.

Results

Nearly three-quarters (n=55/76) of referrals reported anti-tTG titres ≥x10 ULN. Excluding patients with Type 1 Diabetes Mellitus (T1DM) (n=4), who are recommended to have histological confirmation, more than 60% of referrals (n=51/83) had titres ≥x10 ULN and could potentially have fulfilled the ‘non-biopsy’ CD diagnostic criteria.

Conclusions

Implementing these guidelines will reduce invasive investigations, save limited resources, and expedite paediatric CD diagnoses. This will improve the quality of patient care. Is it time to revisit the adult CD diagnostic guidelines?