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Austin and colleagues1 offer an opinion that the recent BSG guidelines on adult coeliac disease are regressive for not considering a biopsy avoidance strategy in patients with positive serological findings.2 The authors cite a positive predictive value (PPV) of up to 100% for serological testing, however studies reporting these findings are from highly selected populations where coeliac disease prevalence is high (six studies, coeliac disease prevalence between 21% and 100%). The most important data that clearly refutes Austin and colleagues’ suggestion is a study of 2000 patients attending endoscopy, where coeliac disease prevalence was 3.9%.3 In this study the PPV of anti-tissue transglutaminase antibody (tTG) was only 28.6%, despite sensitivity and specificity of greater than 90%, which only increased to 71.7% when combined with a positive endomysial antibody (EMA). In simple terms if we follow the approach advocated by Austin and colleagues 3 out of 10 patients would be placed on a …
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