Introduction The BSG guideline for the management of iron-deficiency anaemia (IDA) recommends that all patients should be screened for coeliac disease by coeliac serology. If serology is negative, small bowel biopsies (SBB) are not required at upper GI endoscopy (UGIE), unless other features are present suggesting the diagnosis of coeliac disease. If coeliac serology is positive, coeliac disease should be confirmed by SBB. Previous studies had demonstrated poor compliance with this recommendation.1 The aim of this audit was to assess the number of patients undergoing UGIE for investigation of IDA who were screened for coeliac disease.
Methods Retrospective audit of all patients undergoing UGIE at our institution between January 2007 and May 2008. Patients were identified from the endoscopy database (Unisoft), and coeliac serology and duodenal biopsy results were retrieved from the pathology results system. IDA was defined as Ferritin <12 μg/dl and/or Hb <13.5 in men and <12 in women with MCV <82.
Results During the 15-month period of the audit, a total of 5376 UGIEs were performed. Of these, “anaemia” was recorded as the indication in 825 cases; however, only 424 (7.9%) had confirmed IDA. Of these 424 patients, 122 (28.8%) had anti-endomysial antibodies checked prior to UGIE; positive antibodies were present in 10 (8.2%) of these patients.
SBB was performed in 202 (47.6%) of the 424 patients: 10 patients with positive antibodies (confirmed coeliac disease in 7, equivocal results in 2 and normal histology in 1 patient), 121 with no previous serology test (1 confirmed coeliac disease, 2 equivocal histology), and 71 with negative antibodies (2 confirmed coeliac disease, 1 equivocal histology).
Overall, 243 (57.3%) of the 424 patients with IDA were screened for coeliac disease by either serology or SBB. The diagnosis was confirmed in 10 patients (2.4%), with equivocal histology in a further five patients (1.2%).
Conclusion The results of this audit demonstrate poor compliance with the BSG guideline for coeliac disease screening in IDA.
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