Introduction Duodenal mucosa of normal endoscopic appearance is often biopsied (non-targeted biopsy) to exclude coeliac disease (CD) as the cause of iron deficiency anaemia or other symptoms. Our aim was to investigate the incidence of diagnosis of CD in non-targeted biopsies, in conjunction with tissue transglutaminase antibody (tTG) test results, in 3 adult age groups.
Methods Review of records of 297 consecutive patients having duodenal biopsy from July to October 2011. Age, indication for endoscopy, endoscopic appearance, tTG status and microscopy findings were recorded.
Results See table. Of 297 total patients, age range was 16–93 years. 60 biopsies (20%) were from endoscopically abnormal duodenum and 237 (80%) were from endoscopically normal duodenum, the latter including 12 from patients with follow-up of known CD and 7 with other clinical indication to biopsy normal duodenum. Therefore 218 (73%) were non-targeted biopsies with no indication to biopsy normal duodenum other than to rule out CD. 210 (96%) of the non-targeted biopsies were histologically normal or near normal with no features of CD & the remaining 8 (4%) had histological features consistent with CD. All 8 such patients had positive tTG results, 4 before & 4 after endoscopy, confirming the diagnosis of CD. 60 further patients from the 218 non-targeted group had tTG testing and all were negative. 65 (30%) non-targeted biopsies were from patients aged ≥75 years but CD was not newly diagnosed in this age group. 3 of the 60 patients with endoscopically abnormal duodenum had histological features consistent with a new diagnosis of CD and positive tTG (≤54 years = 1, 55–74 years = 2, ≥75 years = 0).
Conclusion The majority of duodenal biopsies were non-targeted. CD was identified in 4% of non-targeted biopsies, in tTG positive patients. Non-targeted biopsies did not show significant findings in tTG negative patients. Reduction in biopsy workload could be achieved if non-targeted biopsies were to be taken only in the setting of positive tTG or other relevant clinical indication; no significant pathology would be missed as a result. We therefore support the approach of tTG testing prior to endoscopy, to reduce unnecessary biopsies. No new diagnoses of CD were made in patients ≥75 years in our study.
Disclosure of Interest None Declared.
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