Pre-endoscopy serological testing for coeliac disease – a novel approach using rapid antibody testing
Principal investigator: Professor David Sanders
Institution: Royal Hallamshire Hospital, Sheffield
Research classification: Detection, screening and diagnosis
Project completion: 2012
Grant awarded: £21K
Results from transglutaminase-based rapid blood tests can be achieved in 5 to 10 minutes, unlike the results from conventional serological tests which can take several days. This study investigated the use of rapid tests as a guide for clinicians in determining which patients should have a duodenal biopsy taken during endoscopy. Biopsy ensures a high rate of detection of coeliac disease but may not be the most cost effective strategy.
Patients (n = 336) who were referred from primary care for an endoscopy had a duodenal biopsy - the gold standard for detecting coeliac disease, conventional blood tests for IgA tissue transglutaminase antibodies (tTGA) and IgA endomysial antibodies (EMA) and a point of care, transglutaminase based rapid blood test.
Of the 336 patients recruited, 71 of these had newly diagnosed coeliac disease and 265 had a normal duodenal biopsy. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the tTGA, EMA and rapid blood tests were calculated (Table 1).
|Rapid test tTGA||78%||97%||87%||94%|
This is the first study to demonstrate the value of a point of care rapid blood test for adult coeliac disease in endoscopy. The negative predictive value of the transglutaminase based rapid test ensures that the appropriate patients are selected for a duodenal biopsy. This is a potentially cost effective approach.