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Hoyle A, Gillett P, Gillett HR, Borg R, Nottley S, Farrow S, Elgoweini M, Elhassan M, Fletcher J, Whannel G, Gracie E, Morgan S, Jafferbhoy H, Dunbar L, Reid G, Metcalfe EL, Smith G, Harris S, Robertson C, Thomas M, Younger H, Furrie E. No-biopsy strategy for coeliac disease is applicable in adult patients: a 'real-world' Scottish experience. Frontline Gastroenterol 2022; 14:97-102. [PMID: 36818788 PMCID: PMC9933599 DOI: 10.1136/flgastro-2022-102254] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/29/2022] [Indexed: 02/24/2023] Open
Abstract
Objective Emergency interim guidance from the British Society for Gastroenterology (BSG) states that a no-biopsy strategy is possible to diagnose coeliac disease (CD) in adults with elevated transglutaminase IgA antibody (TGA-IgA) levels. We aimed to determine if the suggested TGA-IgA ≥10× ULN is safe and robust in making the diagnosis in adult patients in Scotland. We also aimed to establish if any important co-diagnoses would be missed if no biopsy was performed. Method All positive coeliac serology results for patients aged >15 years in Scotland in 2016 (Grampian 2019) were accessed. Data were collected on demographics, TGA-IgA titres, D1 sampling, histology and macroscopic findings at upper and lower gastrointestinal (GI) endoscopy. Results 1037/1429 patients with positive serology proceeded to biopsy, of which 796/1037 (76.8%) were diagnosed as CD. A total of 320/322 (99.37%) patients with TGA-IgA ≥10× ULN were diagnosed as CD giving the cut-off a positive predictive value of 99.38%. No significant co-pathology was found at endoscopy in these patients. Conclusion Our results show that a no-biopsy strategy using a cut-off of TGA-IgA ≥10× ULN is safe to diagnose CD and that no important pathology would be missed. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition 2020 and BSG COVID-19 interim guidelines are applicable to adult patients in Scotland.
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Affiliation(s)
- Aoisha Hoyle
- Department of Pathology, University Hospital Monklands, NHS Lanarkshire, Airdrie, UK
| | - Peter Gillett
- Department of Paediatric Gastroenterology, Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, UK
| | - Helen R Gillett
- Department of Gastroenterology, St John's Hospital, NHS Lothian, Edinburgh, UK
| | - Reuben Borg
- Department of Pathology, University Hospital Monklands, NHS Lanarkshire, Airdrie, UK
| | - Steven Nottley
- Department of Pathology, University Hospital Monklands, NHS Lanarkshire, Airdrie, UK
| | - Samantha Farrow
- Department of Gastroenterology, St John's Hospital, NHS Lothian, Edinburgh, UK
| | - Maha Elgoweini
- Department of Pathology, University Hospital Crosshouse, NHS Ayrshire and Arran, Ayr, UK
| | - Mohamed Elhassan
- Department of Pathology, University Hospital Crosshouse, NHS Ayrshire and Arran, Ayr, UK
| | - Jonathan Fletcher
- Department of Gastroenterology, Borders General Hospital, NHS Borders, Melrose, UK
| | - Gemma Whannel
- Department of Gastroenterology, Dumfries and Galloway Royal Infirmary, NHS Dumfries and Galloway, Dumfries, UK
| | - Edel Gracie
- Department of Gastroenterology, Dumfries and Galloway Royal Infirmary, NHS Dumfries and Galloway, Dumfries, UK
| | - Sarah Morgan
- Department of Gastroenterology, Victoria Hospital, NHS Fife, Kirkcaldy, UK
| | - Hasnain Jafferbhoy
- Department of Gastroenterology, Victoria Hospital, NHS Fife, Kirkcaldy, UK
| | - Laura Dunbar
- Department of Pathology, Forth Valley Royal Hospital, NHS Forth Valley, Stirling, UK
| | - Gordon Reid
- Department of Pathology, Forth Valley Royal Hospital, NHS Forth Valley, Stirling, UK
| | - Emma L Metcalfe
- Department of Digestive Disorders, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Graeme Smith
- Department of Pathology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sarah Harris
- Department of Pathology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Calum Robertson
- Department of Pathology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Moira Thomas
- Department of Immunology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Hazel Younger
- Department of Gastroenterology, Raigmore Hospital, NHS Highland, Inverness, UK
| | - Elizabeth Furrie
- Department of Immunology Laboratory Services, Ninewells Hospital, NHS Tayside, Dundee, UK
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Younger H, Harrison T, Streckfus C. Relationship among stimulated whole, glandular salivary flow rates, and root caries prevalence in an elderly population: a preliminary study. Spec Care Dentist 1998; 18:156-63. [PMID: 10218063 DOI: 10.1111/j.1754-4505.1998.tb01138.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A comparison of salivary flow rates was made between two groups of healthy, unmedicated, elderly, Caucasian men and women ranging in age from 60 to 90 years. One group was a control group, while the other group had both active and restored root caries. The control group consisted of 69 individuals with a mean age of 73 years. The root caries group consisted of 39 individuals with a mean age of 71 years. The groups were evaluated for unstimulated (UPAR) and stimulated parotid gland flow rates (SPAR), unstimulated (USUB) and stimulated submandibular/sublingual gland flow rates (SSUB), and stimulated whole saliva flow rates (SWhole). Parotid flow rates were determined with the use of a Carlson-Crittenden cup, while submandibular/sublingual flow rates were determined by means of the NIDR collector. A 2% citrate solution was used for stimulation in glandular collections. Subjects chewed a 1-cm3 cube of paraffin to stimulate whole saliva. The results showed that the control group had higher UPAR, SPAR, USUB, SSUB, and SWhole than the root caries group.
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Affiliation(s)
- H Younger
- Office of Research, School of Dentistry, University of Mississippi Medical Center, Jackson 39216-4505, USA
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Harrison T, Bigler L, Tucci M, Pratt L, Malamud F, Thigpen JT, Streckfus C, Younger H. Salivary sIgA concentrations and stimulated whole saliva flow rates among women undergoing chemotherapy for breast cancer: an exploratory study. Spec Care Dentist 1998; 18:109-12. [PMID: 9680920 DOI: 10.1111/j.1754-4505.1998.tb00914.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A study was conducted to evaluate the secretion of stimulated whole saliva (SWS) and secretory IgA (sIgA) among three groups of women. One group was a healthy control group, the second group consisted of women diagnosed with metastatic breast cancer before being placed on chemotherapy, while the third group consisted of women on chemotherapy taking CMF (cyclophosphamide, methotrexate, and fluorouracil) for at least one month. There were seven patients in each group. SWS was collected. Salivary sIgA concentrations were determined by enzyme-linked immunoabsorbant assay. The results of the study showed that the mean SWS flow rate for the chemotherapy group (x = 0.96 mL/min) was significantly lower (p > 0.03) than that of the control group (x = 2.33 mL/min) and lower than that of the group with cancer (x = 1.81 mL/min). Additionally, the results showed that the mean sIgA concentrations for the chemotherapy group (x = 10.9 ng/mg of protein) were slightly lower than those of the control group (x = 13.7 ng/mg of protein) and lower than those of the group with cancer (x = 12.6 ng/mg of protein). The results of this study suggest that women placed on CMF for treatment of carcinoma of the breast may have reduced stimulated salivary production.
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Affiliation(s)
- T Harrison
- Department of Research, School of Dentistry, University of Mississippi Medical Center, Jackson 39216-4505, USA
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