P0426 VARIATION IN THE MANAGEMENT OF COELIAC DISEASE IN WALES

Abstract

Introduction: Coeliac disease (CD) is a life-long immune mediated enteropathy that affects the small intestine in genetically susceptible individuals. There are established guidelines in adult gastroenterology for the management of patients with CD. A recent survey involving parents of children with CD and registered dieticians revealed consensus among parents and dieticians to have specialist CD clinics and annual assessment. In the absence of paediatric guidelines, there is thought to be variation in the management of childhood CD across United Kingdom (UK). This study was carried out to explore the current management practices of children with CD among Consultant Paediatricians in Wales. Methods: All Consultant Paediatricians working in NHS Hospitals/Community Trusts in Wales were electronically sent a standardized questionnaire containing questions focused around follow up, annual assessment and dietetic involvement. Additionally, enquiries were made about screening and diagnosis. Results: 84% (92/110) consultants responded. Most general and/or community paediatricians follow children with CD in their own clinic (43%) or in joint paediatric gastroenterology clinic (20%) with 37% followed up by a paediatric gastroenterologist at their base hospital. 51% consultants replied ‘yes’ to annual assessment of these children and 85% regularly involve dieticians in their clinics. 14% consultants are continuing to obtain small intestinal biopsies using Crosby capsule. To screen CD, 69% request anti tissue transglutaminase antibodies (TTG) alone or in combination with other antibodies. There is considerable variation in the practice of screening at risk groups for CD. Conclusion: This comprehensive survey involving most of the Paediatricians in Wales reveals a heterogeneous practice in the management of children with CD. Guidelines for the management of children and adolescents with CD are needed in the UK.