ORIGINAL ARTICLE

What happens to patients with positive tissue transglutaminase and endomysium antibody results in general practice?

D Sinclair¹, H Duncan²

¹ Department of Clinical Biochemistry, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
² Department of Gastroenterology, Queen Alexandra Hospital

Correspondence to:
Correspondence to:
Dr D Sinclair
Department of Clinical Biochemistry, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK; david.sinclair{at}porthosp.nhs.uk

Background: A previous study showed that many patients with positive gut related antibodies (anti-tissue transglutaminase (TTG) and/or anti-endomysium (EMA) antibodies), indicative of coeliac disease, were not offered a duodenal biopsy, despite the recommendation of the British Society for Gastroenterology guidelines.

Aims/Methods: To investigate whether the addition of a comment on the advisability of referral to a gastroenterologist and biopsy to each positive gut related antibody result would improve the referral rate to investigate possible coeliac disease.

Results: The referral rate improved from 30.1% of patients who were referred and 18% subsequently biopsied before the addition of the comment, to 79.8% who were referred after the introduction of a specific laboratory comment attached to positive antibodies to TTG and/or EMA. All patients with these positive antibodies who were referred for consultant opinion were subsequently biopsied.

Conclusions: To ensure that British Society for Gastroenterology guidelines are followed, laboratories should incorporate more explicit details on the recommended course of action for general practitioners on their receipt of positive gut antibodies to TTG/EMA.

Abbreviations: BSG, British Society for Gastroenterology; CD, coeliac disease; EMA, anti-endomysium antibodies; GFD, gluten free diet; TTG, anti-tissue transglutaminase antibodies

Keywords: general practice; antibodies; biopsy; coeliac

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