Letter: the BSG COVID‐19 interim coeliac disease guidance no‐biopsy approach is safe in adults

Abstract

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

Validation of no‐biopsy pathway for the diagnosis of celiac disease in Asian adults: a multicenter retrospective study

“…Tashtoush et al . also studied 388 adults with CeD and found 167 of 175 patients (95.5%) with IgA anti‐tTG Ab ≥10 × ULN were histologically confirmed (modified Marsh ≥2) 15 . Johnston et al .…”

“…14 Tashtoush et al also studied 388 adults with CeD and found 167 of 175 patients (95.5%) with IgA anti-tTG Ab ≥10 × ULN were histologically confirmed (modified Marsh ≥2). 15 Johnston et al further validated the interim British Society of Gastroenterology guidance of not performing biopsies in patients with anti -tTG Ab titer ≥ 10 folds which had more than 95% probability for translating into a positive biopsy diagnosis of CeD. 16 Losurdo et al further showed that IgA anti-tTG Ab titer ≥10 ULN cutoff had a sensitivity of 51.7%, specificity of 100%, PPV of 100%, and NPV of 91.8% for diagnosis of Marsh ≥2.…”

Review article: Diagnosis of coeliac disease: a perspective on current and future approaches

“…Expert opinion has discouraged mass screening, 212 and instead favoured testing high‐risk groups with >5% likelihood of CD 134 . Informed case‐finding in general practice is effective and can increase diagnoses by as much as 40‐fold, 131,132 but median age at diagnosis is not impacted 213,214 . In contrast, case‐finding in children is not effective, 215,216 and in the United Kingdom 83‐91% of children with CD aged 15 years or younger are thought to be undiagnosed specially in lower socioeconomic groups 177 .…”

“…134 Informed case-finding in general practice is effective and can increase diagnoses by as much 40-fold, 131,132 but median age at diagnosis is not impacted. 213,214 In contrast, case-finding in children is not effective, 215,216 and in the United Kingdom 83-91% of children with CD aged 15 years or younger are thought to be undiagnosed specially in lower socioeconomic groups. 177 In future, mass screening in late childhood may gain support as the most efficient public health measure to address unrecognised CD.…”

Impact of COVID-19 pandemic on pediatric endoscopy: A multicenter study on behalf of the SIGENP Endoscopy Working Group

“…In addition, there have been some reports suggesting that lower threshold of TGA-IgA threshold in EMA-positive children may accurately predict celiac disease [26] . Similarly, a biopsy-sparing approach has been proposed also in adult practice [27] , has been implemented during COVID-19 outbreak ( https://www.bsg.org.uk/covid-19-advice/covid-19-specific-non-biopsy-protocol-guidancefor-those-with-suspected-coeliacdisease/ ) and proven to be safe in adult cohorts [28] .…”