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A no biopsy strategy for adult patients with suspected coeliac disease: making the world gluten-free
  1. Matthew Kurien1,
  2. Jonas F Ludvigsson2,3,
  3. David S Sanders1
  4. on behalf of the authors of the BSG guidelines
  1. 1Gastroenterology and Liver Unit, Royal Hallamshire Hospital & University of Sheffield, Sheffield, UK
  2. 2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  3. 3Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
  1. Correspondence to Professor David S Sanders, Gastroenterology & Liver Unit, Royal Hallamshire Hospital, Room P39, Glossop Road, Sheffield S10 2JF, UK; david.sanders{at}

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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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  • Contributors All authors were involved in the drafting of this letter and approved the final version for submission.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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