PTU-021 Screening for coeliac disease in anaemia with serology and duodenal biopsies: single centred retrospective analysis

Introduction Coeliac disease is an important cause of iron deficiency anaemia with a prevalence of around 1% and BSG guidance suggests that in suspected individuals a minimum of 4 duodenal biopsies should be taken at endoscopy coupled with coeliac serology testing (tissue tranglutaminase – TTG). The aim of this retrospective study was to determine current practices in coeliac testing for patient undergoing upper GI endoscopy for anaemia at a London NHS Trust. Methods This was a retrospective study of all upper gastrointestinal endoscopies performed for anaemia over a 3 month period between September and December 2016. The results of TTG serology endoscopy reports and histological findings were analysed and statistical analysis was performed using Microsoft excel. Results A total of 311 patients underwent upper gastrointestinal endoscopy for anaemia. 2 patients (0.64%) had biopsy proven coeliac disease (subtotal villous atropy on histology). Both these patients had a positive TTG recorded. 38 patients (12.2%) had a TTG recorded prior to endoscopy. 6 patients (1.89%) had a positive TTG. 32 patients had a negative TTG. TTG had a sensitivity of 100%, a specificity of 89%, a positive predictive value of 33% and a negative predictive value of 100%. 210 patients (67.5%) had duodenal biopsies performed. Of these 178 (84.76%) had 4 or more duodenal biopsies. Of 21 patients who had a negative TTG before endoscopy 12 (57.14%) had biopsies. None of these patients were found to have coeliac disease. Conclusions This study demonstrates that the majority of patients receive 4 or more duodenal biopsies at endoscopy as recommended in the guidelines. In addition we have evidence that TTG serology appears a useful negative predictive test which is rarely available prior to endoscopy. Prior testing will help guide the endoscopist and may help avoid costly and unnecessary duodenal biopsies when investigating anaemia. Therefore the uptake of coeliac antibody testing should be encouraged in patients being investigated for anaemia.