6510 Advancements in coeliac disease diagnosis: navigating beyond duodenal biopsies and HLA testing

Objectives The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) 2020 guidelines for diagnosis of paediatric coeliac disease (CD),¹ recommended a shift towards non-invasive diagnosis. These guidelines confirmed that a no-biopsy approach for CD diagnosis is safe in children with high TGA-IgA values ≥10 times the upper limit of normal and positive endomysial antibodies (EMA-IgA) in a second serum sample. Our objective was to evaluate the effect of these guidelines on the diagnosis of CD in a tertiary level gastroenterology centre based in a district general paediatric hospital. Methods A retrospective analysis was performed of a prospective database of patients diagnosed with coeliac disease. The method of diagnosis was compared pre-and post the publication of the guidelines in January 2020. Method of diagnosis was categorised as either serological (including TGA-IgA and EMA-IgA, ±HLA) or biopsy. Results Between January 2012 and June 2023, 185 patients had a documented method of diagnosis. Of these 98 patients were pre-guidelines and 87 were post guidelines. Pre- guidelines, 53 patients (54%) were diagnosed with TGA-IgA and biopsy. This compared to 23 (26%) of patients post-guidelines (p=0.0002). A comparison of the proportion of patients diagnosed on biopsy pre- and post-guidelines is shown in figure 1. Conclusion Since the publication of the 2020 ESPGHAN guidelines on the diagnosis of paediatric CD we observed a significant reduction in the proportion of patients diagnosed by endoscopy and biopsy. This change to less invasive diagnostic serological tests can lead to improved patient experience, earlier CD diagnosis, and potential cost-savings associated with the move away from upper gastro-intestinal endoscopy. Reference S Husby, S Koletzko, I Korponay-Szabó et al. European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. Pediatr Gastroenterol Nutr 2020 Jan;70(1):141–156.