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British Society of Gastroenterology guidelines on the diagnosis and management of coeliac disease
  1. Peter Hill1,
  2. Andrew Austin2,
  3. Julia Forsyth3,
  4. Geoffrey Holmes4
  1. 1Emeritus Consultant Clinical Biochemist, Royal Derby Hospital, Derby, Derbyshire, UK
  2. 2Derby Digestive Diseases Centre, Royal Derby Hospital, Derby, UK
  3. 3Department of Clinical Biochemistry, Royal Derby Hospital, Derby, Derbyshire, UK
  4. 4Emeritus Consultant Gastroenterologist, Royal Derby Hospital, Derby, UK
  1. Correspondence to Dr Andrew Austin, Derby Digestive Diseases Centre, Royal Derby Hospital, Derby, UK; andrew.austin1{at}nhs.net

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The British Society of Gastroenterology (BSG) guidelines1 on diagnosis and management of coeliac disease (CD) contain much useful information, but in our opinion are badly misleading on the important topic of diagnosis and the relative merits of small intestinal biopsy and serology tests. The authors recommend that a duodenal biopsy is essential for diagnosis in all patients and cannot be replaced by serology alone even in a subset of patients.

Other studies have now confirmed earlier work showing that using an appropriate cut-off for IgA-class anti-tissue transglutaminase antibody (IgA-tTG), the diagnosis can be made with a positive predictive value …

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