Reviewed on : 24 Apr 2024

Reviewed by : Dr Victoria Gordon

Expires : 24 Apr 2026

Non-biopsy policy for adults with positive coeliac serology

UHCW has adopted the BSG non biopsy protocol for diagnosis of coeliac disease

OGD D2 biopsy is no longer performed if patient < 55 and no alarm symptoms

Please note:  The laboratory will automatically add anti-endomysial antibody (EMA IgA) antibodies test to a raised TTG result if significantly raised (TTG ≥ 50 KU/L). See flowchart below

Refer to dietetics if coeliac disease confirmed

What we know about using non-biopsy protocol to date:

• IgA tissue transglutaminase (tTG) level of ≥10x the upper limit of normal (ULN) is more than 90% predictive of villous atrophy in the adult population.
• In young people, anti-endomysial antibody test (EMA IgA) testing in a second blood sample serves to reduce the likelihood of a false-positive TTG result and/or the possibility of a recording a transiently elevated tTG titre.
• Where EMA is not available a 2^nd TTG is acceptable

Risks associated with Coeliac Disease

There is an unknown risk to undiagnosed individuals who have coeliac disease but are not on a Gluten Free Diet. This is likely to be comparable to a patient with coeliac disease that has ongoing villous atrophy:

• Haematinic deficiency
• Reduced bone mineral density
• Reduced quality of life
• Increased risk of small bowel lymphoma

Non biopsy protocol

Reference: British Society of Gastroenterology Suggested Protocol Pending Revisions of the BSG Coeliac Disease Guidelines