Introduction Current BSG iron deficiency anaemia guidelines recommend pre-endoscopy serological testing for coeliac disease (CD) and duodenal biopsy only for patients with a positive test. Many patients attending endoscopy for investigation of anaemia do not have serology available. Thus the clinician is then committed to perform a duodenal biopsy. This gap in clinical practice could be bridged by a rapid point of care test (POCT). We aimed, to assess the role of a novel POCT (Simtomax which detects IgA/IgG deamidated gliadin peptide antibodies) in anaemic patients prior to endoscopy.
Method Group 1, a multicentre retrospective analysis of patients attending endoscopy for duodenal biopsy was undertaken in 4 UK hospitals (Addenbrookes, Bradford, Hull, Whipps Cross). Presenting characteristics and availability of serology prior to endoscopy was recorded. Group 2, patients presenting to endoscopy for investigation of anaemia were prospectively recruited. All patients received the POCT prior to their OGD and duodenal biopsy. Results were compared to the gold standard of villous atrophy.
Results Group 1, 2339 patients (58% female, mean age 75.3) underwent duodenal biopsy. Serology was available prior to endoscopy in 912 patients (39%). Anaemia was the most common indication (934 patients, 39.9%). In anaemia, serology was available prior to OGD in 32%. On multivariate analysis of presenting characteristics patients with anaemia were less likely to have serology available than other groups (AOR 0.55 (0.44–0.70) p < 0.0001). CD was more likely if patients had serology prior to their OGD (8.1% vs. 1.1%, p < 0.0001).
Group 2, 129 patients (64% female; mean age 56.6) being investigated for anaemia underwent POCT and duodenal biopsy. 23 patients (17.8%) were diagnosed with CD. Sensitivity, specificity, positive and negative predictive values of the POCT were 100% (82–100), 76% (67–84), 48% (34–63) and 100% (94–100). In this cohort 81 (63%) duodenal biopsies could have been avoided. Based on a cost of £86 for duodenal biopsy this could result in a saving of £5,399 per 100 endoscopies. In a recent 3 month audit in Sheffield 479/2719 (18%) OGDs were performed for anaemia. Using the POCT in Sheffield could save £103,445 per year.
Conclusion Availability of CD serology prior to endoscopy is poor. Diagnostic yield of duodenal biopsy is significantly higher in patients who have had serology prior to their endoscopy (p < 0.0001). An accurate POCT prior to endoscopy could significantly reduce the numbers of unnecessary duodenal biopsies resulting in significant cost savings. In this pilot cohort, Simtomax had 100% sensitivity.
Disclosure of interest P. Mooney: None Declared, L. Svabe: None Declared, K. Andrews: None Declared, S. Moreea: None Declared, I. Haythem: None Declared, S. Hoque: None Declared, J. Elias: None Declared, K. Bundhoo: None Declared, G. Corbett: None Declared, M. Lau: None Declared, L. Wong: None Declared, H. Tsai: None Declared, D. Sanders Grant/ Research Support from: Tillots Pharma, BHR pharmaceuticals for point of care studies into coeliac disease.