Revision of Recommendations COVID-19 Non-biopsy policy for adults with positive coeliac serology
UHCW has adopted the BSG non biopsy protocol during COVID-19 (see flow chart below)
OGD and D2 biopsy is no longer performed if patient < 55 and no alarm symptoms – instead perform EMA test if tTG raised and refer to dietetics
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 2nd tTG is acceptable.
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 on-going villous atrophy.
The risks are of increased :
- 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