Introduction Coeliac disease may be missed at endoscopy. For this reason many centres take routine duodenal biopsies or have a low threshold for duodenal biopsy. While duodenal biopsies demonstrating villous atrophy remains the current gold standard, serological markers are widely used either alone or in combination (tissue transglutaminase (TTG)/endomysial antibody (EMA)) to help identify at risk individuals. However, these results may not be available at the time of endoscopy. Recently a whole blood transglutaminase-based rapid test has become available. This Point of Care Test (POCT) can be read in 5–10 min prior to endoscopy and could help in determining which patients having an endoscopy should have a duodenal biopsy. This strategy could also have cost-saving implications if we could reduce the number of duodenal biopsies performed. This is the first study to assess the clinical utility of this POCT within the setting of endoscopy. Comparisons are made against current serological markers and duodenal biopsy.
Methods Patients undergoing oesophogastroduodenoscopy (OGD) with duodenal biopsies were prospectively recruited between August 2010 and November 2011. Unselected patients undergoing endoscopy were concurrently serologically tested for IgA TTG, EMA, a total IgA immunoglobulin level and the transglutaminase-based rapid test. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the transglutaminase-based rapid test were calculated and comparisons made with TTG and EMA to detect coeliac disease, using duodenal biopsy as the gold standard.
Results 235 patients were recruited (145 female, median age 48, range 17–86). Of these, 51 had newly diagnosed coeliac disease and 184 were controls with a normal duodenal biopsy. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the individual coeliac serological test are demonstrated in Abstract PWE-120 table 1.
Conclusion The Negative Predictive Value of the transglutaminase-based POCT may allow us to adopt this into clinical practice and potentially reduces the number of duodenal biopsies which would be taken at endoscopy.
Competing interests None declared.
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