Introduction Coeliac disease is a common condition, affecting up to 1 in 100 individuals in the UK. The average age of diagnosis is now over the age of 40 with 20% of newly diagnosed cases being over 60. In those over 60, the delay in diagnosis may be particularly long. The purpose of this audit was to evaluate the appropriate use of tissue transglutaminase (tTG) and duodenal biopsy in the diagnosis of celiac disease in a cohort of DGH patients analysed retrospectively.
Methods 114 consecutive patients with a reactive anti tTG > 3 were identified from the Ipswich Hospital Pathology laboratory database between January and June 2011. Those with an anti tTG titre > 7 have positive results in our laboratory. The cohort was divided into positive and negative groups. The duodenal biopsy (DDB) results of the positive group were documented. If the patient had not had a DDB the notes were reviewed or relevant clinician contacted. The negative group’s IgA level was recorded to determine the likelihood of a false negative result.
Results Of 114 patients identified from the database with an anti tTG ≥ 3, 69 were female and 45 male. There were 63 positives and 51 negatives. In the positive serology group, 48 patients were already known to have coeliac disease, 4 had a negative biopsy and 11 have not had a DDB. Of these 11 patients only 2 had been referred to gastroenterology, 3 had been given a diagnosis of coeliac disease without a DDB and 6 had not been informed of their results. In the negative serology group 19 (16 adult and 3 children) were known to have coeliac disease and were on a gluten free diet. Of the remaining 27 adult patients, only 7 (26%) had had their IgA checked, while only 3 of 5 children had had their IgA tested. 2 of these 3 were IgA deficient. The other 2 had not been tested. None of the IgA deficient cohort had undergone a duodenal biopsy to exclude a false negative result.
Conclusion The results of this audit demonstrate inconsistent application of the national guidelines(1) for the diagnosis of celiac disease. Of greatest concern was the cohort of adult patients who were labelled as having coeliac disease without a confirmatory biopsy. There was also a significant cohort of IgA deficient patients in the negative group who may have had celiac disease. There is clearly a need for further on-going education of all healthcare professionals regarding appropriate testing to diagnose coeliac disease to ensure appropriate treatment and prior to labelling an individual with a lifelong diagnosis.
Disclosure of Interest None Declared.
Ciclitira P J, Dewar D H, McLaughlin S D, Sanders DS (2010) The Management of Adults with Coeliac Disease, British Society of Gastroenterology
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