Introduction Coeliac disease (CD) is an abnormal immune response to gluten affecting 1% of the UK population, resulting in small bowel villous atrophy, malabsorption and GI symptoms. A large number of patients are tested for CD and often repeat requests are made. This retrospective analysis looked at the prevalence of patients with positive CD serology in relation to subsequent gastroenterology referrals and/or small bowel biopsy.
Methods The data were collected from patients who had undergone serological CD testing. All patients with a positive anti-tissue transglutaminase, or a positive endomysial antibody test were recorded and notes analysed for referral or endoscopy. We excluded patients under 18 years of age and those with known CD. The data were obtained from the laboratory database at Brighton and Sussex University Hospitals over a period of 1 year.
Results We identified 7369 CD serology requests. The referral source for CD serology was a general practitioner, hospital specialist, gastrointestinal surgeon or gastroenterologist. Overall, 169 (2.3%) individuals had a positive result. From the total number of requests, 6.75% (498) were repeat requests. Of these, 8.23% (41) had a second positive test. 13.86% (69) of the patients who had a repeat serology done by a general practitioner or other hospital clinician were referred to gastroenterology. The overall prevalence of CD was 2.27% (167), of which 58% (97) were referred for a small bowel biopsy. Small bowel histology confirmed CD in 52% of the biopsy samples, that is, almost one third of the total number of cases with positive serology.
Conclusion Positive CD serology was recorded in 2.3% of the study group. Although small bowel histology is the gold standard in the diagnosis of CD,1 this was performed on 58% of the patients with positive serology. It is apparent that not all cases with positive serology are being referred to a specialist. We recommend that patients with suspected or incidental diagnosis of CD should be referred to a gastroenterologist for assessment, confirmation of the diagnosis with small bowel biopsy and advice on gluten-free diet.
Competing interests None declared.
References 1. Ciclitira PJ, Dewar DH, McLaughlin SD, et al. The management of adults with coeliac disease.
2. Crowe SE. Celiac Disease: When to Look and How? ACG 2011 Annual PG Course.
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