Biopsy in adult coeliac disease
Research type
Research Study
Full title
Biopsy in adult coeliac disease
IRAS ID
258267
Contact name
David Sanders
Contact email
Sponsor organisation
Sheffield Teaching Hospitals NHS FT
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Coeliac disease is a multifactorial, autoimmune, multiorgan disease that occurs, upon the ingestion of gluten in genetically determined individuals. The disease may present with a wide spectrum of symptoms and signs. The diagnosis is made out of case finding among at-risk population such as diarrhoea, anaemia, irritable bowel syndrome-like abdominal complaints, fatigue, other autoimmune diseases such as thyroiditis, irritable bowel syndrome or dyspepsia, relatives of a coeliac person with little or no symptoms at all, iron deficiency anaemia, fatigue. In the suspicion of coeliac disease, the presence of highly specific serum antibodies supports the diagnosis. In case of positive serology, the diagnosis is confirmed by a duodenal biopsy obtained by upper endoscopy. The histology of duodenal mucosa detects the gluten-induced mucosal damage. In the most recent years, and in particular after the new European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) criteria for coeliac disease diagnosis in symptomatic children, a debate has been initiated whether if also in a subgroup of adults histology maybe omitted. However, serology does not have a positive predictive value of 100%, and many tests with a different standard of sensitivity are on the market. Endoscopy and biopsy may be required in any case, for example, in cases of anaemia, to search for causes of blood loss. In some cases the histology is normal even in the presence of positive serology and, at the moment, it is not clear if the potential coeliac disease should initiate a gluten free diet. Moreover, in rare cases, adults may present complications already at the moment of diagnosis because adults have a long gluten exposure with an increased risk of death. The aim of this study is to assess the predictive value of serology in the diagnosis of coeliac disease in a high-risk population.
REC name
South Central - Hampshire B Research Ethics Committee
REC reference
19/SC/0259
Date of REC Opinion
2 Jul 2019
REC opinion
Further Information Favourable Opinion