Testing For Celiac Disease Research Articles

Sa1405 Utility of Deamidated Gliadin Peptide Antibody Testing For Celiac Disease

Sa1405 Utility of Deamidated Gliadin Peptide Antibody Testing For Celiac Disease

Is Celiac Disease an Etiological Factor in Children With Migraine?

To determine the prevalence of celiac disease in children and adolescents with migraine, the authors investigated serum levels of tissue transglutaminase antibody immunoglobulin A and total immunoglobulin A from 81 children with migraine and in a healthy control group of 176 children. Study participants who were positive for tissue transglutaminase immunoglobulin A antibodies underwent a duodenal biopsy. Two patients in the migraine group (2.5%) and 1 in the control group (0.57%) tested positive for serum tissue transglutaminase immunoglobulin A antibodies (P > .05). Duodenal biopsy did not confirm celiac disease in both groups, and these patients were considered "potential celiac" cases. In the present study, children with migraine did not exhibit a higher prevalence rate of celiac disease compared with healthy controls. Therefore, the screening test for celiac disease is not a necessary part of the management of migraine in children.

Assessment of coeliac disease prevalence in patients with Down syndrome in Poland - a multi-centre study.

IntroductionThe results of studies assessing whether patients with Down syndrome have increased risk of coeliac disease are contradictory. The prevalence of coeliac disease in patients with Down syndrome is estimated at a wide range between 1% to as much as 18.6%.AimTo assess coeliac disease prevalence in patients with Down syndrome in Poland.Material and methodsThe study enrolled 301 patients with Down syndrome from six centres in Poland (Wroclaw, Sandomierz, Rzeszow, Grudziadz, Katowice, and Bydgoszcz). We measured the concentration of anti-tissue transglutaminase IgA antibodies and anti-deamidated gliadin peptide IgG antibodies in all patients. Patients with abnormal positive (> 10 U/ml) or inconclusive (7–10 U/ml) result of the serological test were offered endoscopic biopsy of the small intestine in the main centre.ResultsIn 31 (10.3%) patients increased concentrations of the investigated antibodies were found, including 19 (6.3%) patients with increased tTg-IgA concentration, 27 (8.97%) patients with increased concentration of DGP-IgG, and 15 (4.98%) patients with increased concentration of both types of antibodies. Endoscopic biopsy of the small intestine was planned for all 31 patients with abnormal results of at least one antibody test and for 2 patients with inconclusive results. One of them suffered from previously diagnosed and histologically confirmed coeliac disease. Biopsy was not conducted in 9 patients due to contraindications, lack of their consent, or introduction of a gluten-free diet by the parents before the examination. In a group of 23 patients who underwent endoscopic biopsy of the small intestine, in 15 patients the histopathological picture of the small intestinal mucosa was typical for coeliac disease, 2 patients were diagnosed with lesions of grade 1 according to the classification by Marsh-Oberhuber, 1 patient was diagnosed with focal shortening of villi and hypertrophy of the crypts with no intraepithelial lymphocytosis (remains under gastrological observation), 2 patients were diagnosed with mucosal inflammation of the duodenum, and 3 patients were found to have a normal histopathological picture of the small intestine. Analysis of the data included in the questionnaires of all patients showed no statistically significant differences in the body height, body mass index, prevalence of abdominal pain, diarrhoea, constipations, recurrent stomatitis, enamel hypoplasia, thyroid diseases, or hypertransaminasaemia between the groups of patients with normal and abnormal serological test results. Significantly higher prevalence of abdominal flatulence (p < 0.05) and epilepsy (p < 0.05) was found in the group of patients whose serological test results were negative.ConclusionsPatients with Down syndrome are a high-risk group for coeliac disease in the Polish population, with an estimated prevalence of at least 5.4%. Serological tools based on tTG-IgA and DGP-IgG tests are useful for the diagnosis of coeliac disease in Down syndrome patients. tTG-IgA test may be superior to DGP-IgG test in patients with normal total IgA level. Tests for coeliac disease should be carried out in all Polish patients with Down syndrome, regardless of the clinical picture.

Serological tests for celiac disease in Moroccan patients with type 1 diabetes

La maladie cœliaque (MC) est l'une des maladies auto-immunes les plus fréquemment associées au diabète de type 1 (DT1). La prévalence de MC dans DT1 varie de 3 à 6%. La présentation clinique de MC dans DT1 est classé comme asymptomatiques dans environ la moitié des cas. L'objectif de notre étude est de déterminer la fréquence des auto-anticorps anti-transglutaminase tissulaire (AtTG) et anti-gliadines (AAG) chez les patients diabétiques de type 1 dans le but de recommander une éventuelle biopsie jéjunale et d'instaurer un régime sans gluten précocement avant l'installation des signes cliniques et des complications de la maladie cœliaque. Les sujets inclus dans cette étude sont des patients atteints de DT1 non traités pour la MC et qui ne présentent pas de signes en faveur de cette pathologie. La détection des AtTG de classe IgG et IgA et AAG classe IgG et IgA a été réalisée par technologie Luminex. Nous avons inclus 31 patients. Il s'agit de 16 hommes et 15 femmes. Les AAG de classe IgA étaient positifs chez 4(13%) patients et chez 7(22,5%) patients pour les IgG. Les AtTG de classe IgA étaient positifs chez 3(10%) patients et chez une patiente (3%) pour les IgG. Dans notre étude l'association du diabète type 1 et des marqueurs biologiques de la MC n'est pas rare d'où l'intérêt de son dépistage systématique chez des diabétiques de type 1. Le diagnostic de cette forme atypique et silencieuse de la MC est important compte tenu du risque de complications sérieuses à type de malabsorption et de cancers digestifs.

Frequency of Celiac Disease in Patients With Increased Intestinal Gas (Flatulence)

Excessive flatulence which impairs social performance in patients is one of the common reasons for referrals to gastroenterology clinics. Celiac Disease is a rare but important cause of increased intestinal gas (bloating) and if not diagnosed, patients face complications such as malabsorption, anemia, osteoporosis and even intestinal lymphoma. This study aimed to determine the frequency of Celiac Disease in patients with excessive flatulence. One hundred and fifty patients with a chief complaint of experiencing flatulence more than 15 times a day and lasting for three months were referred to the gastroenterology clinic of Rasoul-e-Akram Teaching Hospital. Serological tests for Celiac Disease, Anti TTG Ab (IgA-IgG) were requested and the patients with positive tests underwent upper GI endoscopy. Biopsies of the second part of the duodenum were then sent to the laboratory. From one hundred and thirty patients who completed the study, 92 (70.7%) were female. Mean age of the patients was 32 ± 13 years. Anti TTG Ab was found in 5 patients (3.85%). Only 2 patients (1.5%) had a documented positive pathology for Celiac Disease. According to the results of this study and other studies, we conclude that Celiac Disease is an uncommon etiology for excessive flatulence but it is of importance to investigate it in excessive flatulence patients.

Issue Highlights

Issue Highlights

Severe intestinal malabsorption associated with olmesartan: a French nationwide observational cohort study.

Severe sprue-like enteropathy associated with olmesartan has been reported, but there has been no demonstration of an increased risk by epidemiological studies. To assess, in a nationwide patient cohort, the risk of hospitalisation for intestinal malabsorption associated with olmesartan compared with other angiotensin receptor blockers (ARB) and ACE inhibitors (ACEIs). From the French National Health Insurance claim database, all adult patients initiating ARB or ACEI between 1 January 2007 and 31 December 2012 with no prior hospitalisation for intestinal malabsorption, no serology testing for coeliac disease and no prescription for a gluten-free diet product were included. Incidence of hospitalisation with a discharge diagnosis of intestinal malabsorption was the primary endpoint. 4 546 680 patients (9 010 303 person-years) were included, and 218 events observed. Compared with ACEI, the adjusted rate ratio of hospitalisation with a discharge diagnosis of intestinal malabsorption was 2.49 (95% CI 1.73 to 3.57, p<0.0001) in olmesartan users. This adjusted rate ratio was 0.76 (95% CI 0.39 to 1.49, p=0.43) for treatment duration shorter than 1 year, 3.66 (95% CI 1.84 to 7.29, p<0.001) between 1 and 2 years and 10.65 (95% CI 5.05 to 22.46, p<0.0001) beyond 2 years of exposure. Median length of hospital stay for intestinal malabsorption was longer in the olmesartan group than in the other groups (p=0.02). Compared with ACEI, the adjusted rate ratio of hospitalisation for coeliac disease was 4.39 (95% CI 2.77 to 6.96, p<0.0001) in olmesartan users and increased with treatment duration. Olmesartan is associated with an increased risk of hospitalisation for intestinal malabsorption and coeliac disease.

Attitudes Toward Genetic Testing for Celiac Disease.

HLA molecular typing for celiac disease (CD) is a genetic test with a high negative predictive value. The aim of this study is to explore knowledge of and attitudes towards genetic testing (GT). A 25-item questionnaire was developed by a multidisciplinary team and distributed to members of CD support groups across the United States. Respondents (n = 1835) were mainly female (88 %), married (76 %), and college-educated (55 %), with a median age range of 31-50 years. Those who were married (82 vs 75 %, p = 0.002), had children (82 vs 74 %, p < 0.001), and had pursued education beyond high school (81 vs 68 %, p = 0.004) were more likely to be aware of the availability of GT. On multivariable analysis, adjusting for age, sex, education, marital status, region of residence, and having children, college-education (OR 2.05, 95 % CI: 1.33-3.16) and having children (OR 1.56, 95 % CI: 1.15-2.11) remained significant predictors of GT awareness. A majority of patients with a personal or family history of CD planned GT for their children, and the most common concerns regarding GT were cost and impact on health care and/or insurance. In conclusion, awareness of GT is high among CD support group members. Efforts should be made to increase knowledge of GT in those with a lower educational level, and healthcare professionals should attempt to address concerns regarding GT cost and the impact of results on health care and insurance status.

Evaluation of coeliac disease serological markers

Background: celiac disease, is an autoimmune inflammatory disease of the small intestine that is precipitated by the ingestion of gluten, a component of wheat protein, in genetically susceptible persons. Serologic tests for antibodies against Endomysium, Reticulin, and Gliadin identify most patients with the disease. Early diagnosis and management are important to forestall serious consequences of malabsorption, such as osteoporosis and anemiaAims of the study: This study compared the sensitivity, specificity, and predictive value of, anti-reticulin and anti-gliadin antibodies according to anti endomysium antibodies , in consecutive patients investigated for celiac disease antibodies.Patient&amp; Methods: Total 509 patients (236 males&amp;273 females) celiac disease patients who were referred to the immunology department in Teaching labs from January till December 2012 for serological detection of auto antibodies . Anti- Gliadin (IgG &amp;IgA ) were measured by Enzyme Linked Immunosorbent Assay. whereas Anti-Endomyseal IgA &amp; Anti-Reticulin IgA were detected by Indirect immunofluorescent technique on monkey oesophagus &amp; kidney tissue respectively.Results: Most the cases for celiac disease were reported in the age group (1-10)years as antibodies against Gliadin (IgG,IgA) ,Anti-Endomesial IgA antibodies and anti-Reticulin IgA were detected in 130(66.7%),127(65.8%),39(79.6%) and 49(68.1%) respectively. Both anti-Gliadin IgA and anti Reticulin were detected significantly in females p values( 0.047, 0.008) respectively. The study showed that anti-Gliadin IgA is the most sensitive according to anti Endomyseal IgA and anti Reticulin was the most specific for screening of celiac disease. ; While Receiver Operating Characteristic (ROC) curve showed that anti gliadin IgA had the best sensitivity and specificity according to anti Endomysium test results.Conclusion: Predictive performance of the serological celiac disease tests showed that anti Gliadin IgA had the best sensitivity &amp;specificity according to traditional anti Endomysium antibody test results.

Is Celiac Disease an Etiological Factor in Children with Nonsyndromic Intellectual Disability?

To determine the prevalence of celiac disease in children and adolescents with nonsyndromic intellectual disability, we investigated serum levels of tissue transglutaminase antibody and total IgA from 232 children with nonsyndromic intellectual disability and in a healthy control group of 239 children. Study participants who were positive for tissue transglutaminase antibody underwent a duodenal biopsy. A total of 3 patients in the nonsyndromic intellectual disability group (5.45%) and 1 in the control group (0.41%) had positive serum tissue transglutaminase antibody (P > .05). Duodenal biopsy confirmed celiac disease in only 1 patient who had nonsyndromic intellectual disability. In this present study, children with nonsyndromic intellectual disability did not exhibit a higher celiac disease prevalence rate compared with healthy controls. Therefore, we suggest that screening test for celiac disease should not be necessary as a part of the management of mild and moderate nonsyndromic intellectual disability. However, cases of severe nonsyndromic intellectual disability could be examined for celiac disease.

PTU-320 Pre-endoscopy point of care testing for coeliac disease in anaemia: a cost saving economic model

<h3>Introduction</h3> 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. <h3>Method</h3> 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. <h3>Results</h3> 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 &lt; 0.0001). CD was more likely if patients had serology prior to their OGD (8.1% vs. 1.1%, p &lt; 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. <h3>Conclusion</h3> 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 &lt; 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. <h3>Disclosure of interest</h3> 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.

PTH-252 Investigation of iron deficiency anaemia. duodenal biopsies – are they worth it?

<h3>Introduction</h3> The prevalence of iron deficiency anaemia (IDA) in adult men and postmenopausal women in the developed world is 2–5%.¹British Society of Gastroenterology (BSG) IDA Guidelines recommend tissue transglutaminase (tTG) antibody as a screening test for coeliac disease. Indications for duodenal biopsies include patients with diarrhoea, weight loss and positive tTG serology. Where coeliac serology is positive, duodenal bulb and D2 biopsies should be taken.²BSG IDA Guidelines do not recommend duodenal biopsy for tTG negative, asymptomatic patients.³However a separate BSG guideline for diagnosis of coeliac disease recommends duodenal biopsies in IDA patients irrespective of Coeliac serology due to the finding of seronegative coeliac disease.² <h3>Method</h3> This audit was carried out to assess adherence to BSG IDA Guidelines for duodenal biopsies in patients referred for IDA investigation with negative tTG antibodies. The study also set out to establish the positive diagnostic yield where biopsies were taken in the same cohort. Patients referred to Newcastle upon Tyne NHSFT adult IDA service between 2011 and 2014 identified as ttG negative and who underwent endoscopy were included. <h3>Results</h3> Two hundred patients were identified, median age 66 (range 19–91); 126 (63%) female and 74 (37%) Male. 114 (57%) patients had duodenal biopsies taken despite tTG being negative and asymptomatic. 28 (19.7%) patients were symptomatic and duodenal biopsies taken, though only 8 (28%) of these patients had 4 biopsy samples and none were from duodenal bulb. Where biopsies were taken, none confirmed coeliac disease. 5/142 (3.5%) patients biopsied had lymphocytic duodenitis but none of them were subsequently diagnosed or treated as coeliac disease. <h3>Conclusion</h3> Duodenal sampling in tTG negative patients did not yield any additional positive diagnosis of coeliac disease. This confirms the recommendations of BSG IDA guidelines. The results of this audit do not appear to support the recommendations made within the BSG coeliac disease guideline for duodenal biopsy being performed regardless of coeliac serology. However, the fact that only 4.9% of patients who had duodenal biopsies taken had duodenal bulb sampled, may limit this conclusion. More efficient use of local endsoscopy and pathology resources can occur by appropriate selection of patients on whom to perform duodenal biopsies. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Guralnik JM, Eisenstaedt RS, Ferrucci L, <i>et al</i>. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anaemia. Blood 2004;<b>104</b>:2263e8 Diagnosis and management of adult coeliac disease: Guidelines from British Society of Gastroenterology June10, 2014(10.1136/gutjnl-2013-306578) BSG Guidelines for the management of Iron deficiency anaemia May 2011

PTU-154 Primary care detection of coeliac disease by means of serology is no better than random population screening: Abstract PTU-154 Table 1

<h3>Introduction</h3> The prevalence of coeliac disease in the UK is 1%, but only approximately 1 in 6 patients have been diagnosed.¹NICE Guidelines give a list of indications for testing for coeliac disease.²12 months of coeliac serology (anti-tTG) requests in our local laboratory were reviewed to assess variation in serology requesting and detection of coeliac disease across 23 local GP practices. This was compared with requests from secondary care. <h3>Method</h3> All anti-tTG requests, with clinical indications, between December 2013 and December 2014 were obtained from the York Hospital (YH) Laboratory. All positive D2 biopsies were obtained from the YH Pathology Database and were cross-referenced to obtain the crude rate of referral for D2 biopsy. Only newly diagnosed patients were analysed. Categorical data was analysed by means of a Chi-squared contingency table with Yates’ correction. A two-tailed P value of &lt;0.05 was considered significant. <h3>Results</h3> There were a total of 15,183 (male 36%) anti-tTG requests – 11,321 from primary care and 3,862 from secondary care. The most common indications for serological testing were “anaemia” (13%), “no details given” (11.3%), “diarrhoea” (10.5%) and “abdominal pain” (9.2%). “Osteoporosis”, osteomalacia”, “fracture”, or similar was given as a clinical indication for 0% of the requests. 133 (1.2%) of the requests from primary care yielded a positive result compared with 96 (2.5%) of the requests from secondary care (P &lt; 0.0001). Of these 229 patients (38% male), 204 (89%) went on to have a D2 biopsy (mean waiting time 6.6 weeks). Of those biopsied, 191 (94%) had coeliac disease confirmed. Percentage of total practice list size tested for coeliac serology varied from 0.05% to 21.4% with percentage testing positive varying from 0% to 6.51% (see Table 1). <h3>Conclusion</h3> There is poor selection of patients for coeliac serology testing in the community. Better education for checking coeliac serology in poor bone health is needed. The crude positive serology rate in the community was no better than random sampling from the population. This data suggests either the wrong patients are being tested or those with undiagnosed coeliac disease do not have regular contact with primary care. The reasons for variation in crude testing rates need to be explored further. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> West, <i>et al</i>. Am J Gastroenterol. 2014 NICE CG86. May 2009

PTU-159 Comparison of three commercially available point of care tests for coeliac disease: Abstract PTU-159 Table 1

<h3>Introduction</h3> Coeliac disease (CD) remains underdiagnosed. A rapid point of care test (POCT) may increase uptake of serological testing in appropriate patient groups. 3 POCTs are commercially available in the UK and in continental European pharmacy outlets: Biocard an IgA tissue tranglutaminase (tTG) test (BHR pharmaceuticals); Celiac Quick Test (Biohit Healthcare) detecting IgA, IgG and IgM tTG and Simtomax (Tillotts Pharma) which detects IgA and IgG antibodies against deamidated gliadin peptides (DGP). A fourth POCT has also been developed but not marketed (Xeliac Test Pro, Personal Diagnostics), with availability being solely from the manufacturer and no published data existing supporting its validity. Of the 3 commercially available POCTs, there is a limited evidence base with significant ascertainment bias. For this reason we decided to compare 3 commercially available tests in an endoscopic setting. <h3>Method</h3> Patients referred with a positive endomysial antibody (EMA) for duodenal biopsy to confirm CD were recruited. All patients had repeat serum EMA, tTG and immunoglobulins and were tested simultaneously with the 3 POCTs as per the manufacturers’ instructions. All patients had quadrantic duodenal biopsies from the second part of the duodenum as well as a duodenal bulb biopsy. Demonstration of villous atrophy (VA) was required to diagnose CD. <h3>Results</h3> 82 patients (51.2% female, mean age 41.0) have been recruited. In 10 patients the EMA had normalised on repeat testing. None of these patients had VA on duodenal biopsy. 9 of these patients were referred with a weak EMA and had a negative tTG. One patient had a tTG of 10 times the upper limit of normal, and subsequent gluten challenge revealed a positive EMA and VA. Of the remaining 72 patients 59 new cases of CD were confirmed with the presence of villous atrophy, of the 13 EMA positive patients without VA 8 had Marsh 1 or 2 changes present with the remaining 5 patients having normal histology. Full sensitivity, specificity PPV and NPV for all of the tests compared to VA on duodenal biopsy are shown in Table 1. <h3>Conclusion</h3> In this pilot data set Simtomax appears to be the most sensitive of the POCTs when compared to histology with similar results to serum tTG as screening test. Further work is required in larger cohorts and lower prevalence populations to confirm the utility of these tests in adult CD. <h3>Disclosure of interest</h3> P. Mooney: None Declared, S. Wong: None Declared, M. Burden: None Declared, M. Kurien: None Declared, M. Hadjivassiliou: None Declared, D. Sanders Grant/ Research Support from: BHR pharmaceuticals; Tillotts Pharma for investigator led studies.

PTU-163 The role of serology testing and duodenal biopsy for the investigation of coeliac disease in patients with unexplained anaemia

Introduction Current guidelines recommend testing for Coeliac Disease in all patients undergoing investigation for anaemia with either serology testing, for tissue transglutimase antibody (TTG) or duodenal (D2) biopsies to confirm histological evidence of intestinal damage. The present study aimed to assess the approach for diagnosing Coeliac Disease by (i) examining current practice and (ii) assessing the efficacy of TTG testing. Method A retrospective audit of all adult patients undergoing upper GI endoscopy at a single centre, between August 2013 and July 2014 (inclusive), was performed. A database was created with demographics including age, sex, socioeconomic deprivation, haemoglobin level (Hb), TTG serology result, D2 biopsy result and findings at endoscopy. Results During the study period, 4,788 patients underwent upper GI endoscopy, of which unexplained anaemia was the indication in 814 (17%). Of these, complete results were available for 789 (97%), which were included for analysis. Mean age 66 years, 440 (56%) female, 296 (38%) socioeconomically deprived. Mean Hb levels were 102 g/L (males) and 97 g/L (females). Of these, 580 (74%) patients underwent investigation for Coeliac Disease (79 TTG serology only; 334 D2 biopsy only; 167 both) of which 14 (2%) patients had histological confirmation of the disease. Of the 209 patients who were not screened for Coeliac Disease, 144 (64%) had an alternative source of bleeding found at time of endoscopy. Patients with confirmed Coeliac Disease were likely to be younger (p = 0.017) than those without. There was no association between sex (p = 0.473), deprivation (p = 0.235) or Hb level (p = 0.856 (males), p = 0.543 (females)) and the risk of Coeliac Disease. Of those undergoing both TTG and D2 biopsy (n = 167), 2 patients had negative TTG serology and positive D2 biopsy and 1 patient had positive TTG and negative D2 biopsy, yielding an estimated sensitivity and specificity of TTG serology testing of 82% and 99% respectively. Conclusion The results of the present study indicate that the majority of patients undergoing endoscopy for investigation of anaemia, in our single centre, are appropriately investigated for Coeliac Disease. However, TTG has reduced sensitivity and within a cohort of patients who will be undergoing endoscopy its role is limited. Disclosure of interest None Declared.

Issue Highlights

Issue Highlights

Evidence Against Routine Testing of Patients With Functional Gastrointestinal Disorders for Celiac Disease: A Population-based Study

Celiac disease has been linked to irritable bowel syndrome (IBS)-like symptoms in outpatient clinics. Guidelines recommend that all patients with IBS-like symptoms undergo serologic testing for celiac disease, but there is controversy over whether celiac disease is more prevalent in populations with IBS-like symptoms. We aimed to determine whether positive results from serologic tests for celiac disease are associated with IBS and other functional gastrointestinal disorders (FGIDs) in a large U.S. white population. Validated, self-report bowel disease questionnaires (BDQs) were sent to randomly selected cohorts of Olmsted County, Minnesota residents. In separate protocols, serum samples were collected from more than 47,000 Olmsted County residents without a prior diagnosis of celiac disease; we performed serologic tests for celiac disease on stored serum samples from residents who completed the BDQ. Logistic regression was used to test for the association between serologic markers of celiac disease (positive vs negative) and individual FGIDs. A total of 3202 subjects completed the BDQ and had serum available for testing. IBS was identified in 13.6% of these subjects (95% confidence interval [CI], 12.4%-14.8%), and any gastrointestinal symptom occurred in 55.2% (95% CI, 53.5%-56.9%). The prevalence of celiac disease on the basis of serologic markers was 1.0% (95% CI, 0.7%-1.4%). IBS was less prevalent in patients with celiac disease (3%) than patients without celiac disease (14%), although the difference was not statistically significant (odds ratio, 0.2; 95% CI, 0.03-1.5). Abdominal pain, constipation, weight loss, and dyspepsia were the most frequent symptom groups in subjects who were seropositive for celiac disease, but none of the gastrointestinal symptoms or disorders were significantly associated with celiac disease serology. Symptoms indicative of FGIDs and seropositive celiac disease are relatively common in a U.S. white community. Testing for celiac disease in patients with IBS in the community may not have a significantly increased yield over population-based screening in the United States.

846 Cost-Effectiveness of Routine Duodenal Biopsy for Celiac Disease Screening in Patients Undergoing Endoscopy for the Evaluation of Refractory Gastroesophageal Reflux

Background: Patients with refractory gastroesophageal reflux disease (GERD) may have undiagnosed celiac disease. These patients often undergo esophagogastroduodenoscopy to determine the etiology and severity of GERD. Because a duodenal biopsy is the gold standard for diagnosing celiac disease and a gluten-free diet is an effective treatment, performing routine duodenal biopsy during endoscopy may result in early diagnosis and symptom improvement, allowing for discontinuation of proton pump inhibitor therapy. We aimed to evaluate the cost-effectiveness of performing routine duodenal biopsy during endoscopy for diagnosing celiac disease in patients with refractory GERD. Methods: We constructed a decision tree using data from published literature to calculate cost-effectiveness of endoscopy with and without duodenal biopsy in a cohort of 10,000 40-year-old patients. Results: We found that the biopsy strategy would detect 70 out of 100 celiac disease patients in a cohort of 10,000 GERD patients undergoing endoscopy if the prevalence of celiac disease was 1% in this cohort. Up-front biopsy would increase the remaining quality-adjusted life years (QALYs) by 0.0032. Testing for celiac disease using this approach would increase the lifetime cost by $389 per patient. Compared with no biopsy, the biopsy strategy cost $55,693 per celiac case detected, and $121,875 per QALY gained. The incremental cost-effectiveness ratio (ICER) met the threshold of 1.8%, the specificity of biopsy was >98%, the cost of gluten-free diet was $5,874 per year. Increasing the sensitivity of duodenal biopsy to 100% did not affect the cost-effectiveness threshold. Conclusion: Esophagogastroduodenoscopy with duodenal biopsy for refractory GERD patients can be a cost-effective approach for screening when the prevalence of celiac disease in this patient population is 1.8% or greater.

847 Evaluation of Antibodies to Cytolethal Distending Toxin B (CdtB) and Vinculin in Celiac Disease

Background: Patients with refractory gastroesophageal reflux disease (GERD) may have undiagnosed celiac disease. These patients often undergo esophagogastroduodenoscopy to determine the etiology and severity of GERD. Because a duodenal biopsy is the gold standard for diagnosing celiac disease and a gluten-free diet is an effective treatment, performing routine duodenal biopsy during endoscopy may result in early diagnosis and symptom improvement, allowing for discontinuation of proton pump inhibitor therapy. We aimed to evaluate the cost-effectiveness of performing routine duodenal biopsy during endoscopy for diagnosing celiac disease in patients with refractory GERD. Methods: We constructed a decision tree using data from published literature to calculate cost-effectiveness of endoscopy with and without duodenal biopsy in a cohort of 10,000 40-year-old patients. Results: We found that the biopsy strategy would detect 70 out of 100 celiac disease patients in a cohort of 10,000 GERD patients undergoing endoscopy if the prevalence of celiac disease was 1% in this cohort. Up-front biopsy would increase the remaining quality-adjusted life years (QALYs) by 0.0032. Testing for celiac disease using this approach would increase the lifetime cost by $389 per patient. Compared with no biopsy, the biopsy strategy cost $55,693 per celiac case detected, and $121,875 per QALY gained. The incremental cost-effectiveness ratio (ICER) met the threshold of 1.8%, the specificity of biopsy was >98%, the cost of gluten-free diet was $5,874 per year. Increasing the sensitivity of duodenal biopsy to 100% did not affect the cost-effectiveness threshold. Conclusion: Esophagogastroduodenoscopy with duodenal biopsy for refractory GERD patients can be a cost-effective approach for screening when the prevalence of celiac disease in this patient population is 1.8% or greater.

Sa1305 Point of Care Testing for Adult Coeliac Disease: A Potential Role in Endoscopy

Sa1305 Point of Care Testing for Adult Coeliac Disease: A Potential Role in Endoscopy