Introduction Current guidelines recommend testing for Coeliac Disease in all patients undergoing investigation for anaemia with either serology testing, for tissue transglutimase antibody (TTG) or duodenal (D2) biopsies to confirm histological evidence of intestinal damage. The present study aimed to assess the approach for diagnosing Coeliac Disease by (i) examining current practice and (ii) assessing the efficacy of TTG testing.
Method A retrospective audit of all adult patients undergoing upper GI endoscopy at a single centre, between August 2013 and July 2014 (inclusive), was performed. A database was created with demographics including age, sex, socioeconomic deprivation, haemoglobin level (Hb), TTG serology result, D2 biopsy result and findings at endoscopy.
Results During the study period, 4,788 patients underwent upper GI endoscopy, of which unexplained anaemia was the indication in 814 (17%). Of these, complete results were available for 789 (97%), which were included for analysis. Mean age 66 years, 440 (56%) female, 296 (38%) socioeconomically deprived. Mean Hb levels were 102 g/L (males) and 97 g/L (females). Of these, 580 (74%) patients underwent investigation for Coeliac Disease (79 TTG serology only; 334 D2 biopsy only; 167 both) of which 14 (2%) patients had histological confirmation of the disease. Of the 209 patients who were not screened for Coeliac Disease, 144 (64%) had an alternative source of bleeding found at time of endoscopy. Patients with confirmed Coeliac Disease were likely to be younger (p = 0.017) than those without. There was no association between sex (p = 0.473), deprivation (p = 0.235) or Hb level (p = 0.856 (males), p = 0.543 (females)) and the risk of Coeliac Disease. Of those undergoing both TTG and D2 biopsy (n = 167), 2 patients had negative TTG serology and positive D2 biopsy and 1 patient had positive TTG and negative D2 biopsy, yielding an estimated sensitivity and specificity of TTG serology testing of 82% and 99% respectively.
Conclusion The results of the present study indicate that the majority of patients undergoing endoscopy for investigation of anaemia, in our single centre, are appropriately investigated for Coeliac Disease. However, TTG has reduced sensitivity and within a cohort of patients who will be undergoing endoscopy its role is limited.
Disclosure of interest None Declared.
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