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  4. Pre-endoscopy serological testing for coeliac disease – a novel approach using rapid antibody testing

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).

Serological test Sensitivity Specificity PPV NPV
tTGA 90% 82% 58% 97%
EMA 79% 97% 89% 95%
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.

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