6324 Coeliac disease 2005–2011 vs 2015–2022; more cases, more symptoms and fewer biopsies than before

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Objectives Coeliac Disease(CD) occurs in around 1% of children, but most remain undiagnosed. Historically, diagnosis required demonstration of typical small intestinal biopsy abnormalities ESPGHAN 1980/91.1 Since BSPGHAN 20132 & ESPGHAN guidelines 2012,3 no biopsy is necessary if immunoglobulin-A tissue transglutaminase(IgA-TTG) is >10 times upper limit of normal(>10xULN). Using contemporaneous guidelines as standards we aimed to: Audit practice in Cardiff and Vale University Health Board(CAVUHB) 2015–2022 Compare the rate of detected CD to our previous study 2005–20114 Identify numbers diagnosed via biopsy and non-biopsy Methods Patients aged 0–16(Population<17 around 92,000) investigated for CD between 01/01/2015–31/12/2022 were sought. Data was obtained from 3 different sources to maximize patient capture: laboratory IgA-TTG results, biopsy lists and dietetic records. Duplications were discounted. Electronic case notes were analysed for demographics, symptoms and blood results. Results From the 246 individuals identified as possible cases, 192 children (69male:123female) were diagnosed. Graph 1 shows that pre-pandemic(2015–2019) 21–33 cases/year were diagnosed; during the pandemic this fell to 11/year(2020). Mean annual incidence was 28/100,000 pre-pandemic and 21/100,000 peri-pandemic. Most patients were symptomatic 153(79.7%); commonest symptoms being, abdominal pain(50.5%), diarrhoea(25.5%), fatigue(17.7%) and constipation(15.6%). 92 patients had an IgA-TTG result >10xULN and were diagnosed without biopsy, leaving 100 requiring biopsy. 19 had an IgA-TTG result <10xULN but >5xULN. 6 of these declined endoscopy. The remaining 13 all received a CD diagnosis after biopsy. IgA-TTG results and outcomes for patients investigated for CD is shown in table 1. Conclusion Pre-pandemic CD incidence was steadily rising, but halved during the COVID pandemic. Compared to our previous study 2005–2011vs2015–2022, the mean rate of diagnosis is slightly higher despite COVID 23 vs 26/year, higher female: male ratio continues 58:42% to 64:36%, whilst asymptomatic diagnoses have decreased from 36% to 20%. Half of diagnoses are now made without biopsy. Virtually all patients biopsied with an IgA-TTG >5xULN were diagnosed with CD. Should threshold for non-biopsy diagnosis fall to >5xULN? References Walker-Smith JA, Guandalini S, Schmitz J, et al. Revised criteria for diagnosis of coeliac disease: report of working group of European Society of Paediatric Gastroenterology and Nutrition. Arch Dis Child 1990;65:909–911. Murch S, Jenkins HR, et al. Coeliac disease in children for the diagnosis and management of Joint BSPGHAN and Coeliac UK guidelines, 2013. Arch Dis Child 2013;98:806- 811. Husby S, et al. ESPGHAN guidelines for the diagnosis of coeliac disease in children and adolescents. JPGN 2012;54:136–60. Whyte LA, Jenkins HR. The epidemiology of coeliac disease in South Wales: a 28-year perspective. Arch Dis Child 2013;98(6):405–7.

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