Coeliac diagnosis confirmed without biopsies
Diagnosis of coeliac disease can be confirmed without the need for duodenal biopsies by using a high threshold level of anti-tissue transglutaminase antibody (aTTG), Canadian researchers say.
In a retrospective study of 440 adult patients with positive aTTG titres they sought to define a level of aTTG for which histology results were consistently positive.
They found that using the Youden Index, the optimal cut-off for IgA-TTG titres was 2.8 times the upper limit of normal (ULN) with a sensitivity of 81.04% and specificity of 88.16%. To achieve a PPV of 100%, the cut-off for aTTG titres would be 8.76 ULN with a sensitivity of 50% and a specificity of 100%.
Presenting their findings at the recent American College of Gastroenterology meeting, the study investigators noted that 67% of the CD patients were female and more than 93% were symptomatic at the time of the study, with diarrhoea being the most frequent presenting symptom.
They also observed that none of the patients with a potential CD (positive serology, unremarkable histopathology) developed complications during a two-year period after initial biopsy.
Diagnosing CD without biopsies may be of clinical importance during the pandemic era when access to upper endoscopy in a timely manner is becoming increasingly difficult, they suggested.
US gastroenterology groups advise CRC screening from 45
New guidance from the US Multi-Society Task Force (MSTF) on Colorectal Cancer (CRC) recommends that clinicians now offer CRC screening in average-risk individuals from the age of 45.
In an update to previous guidelines released in 2017, the group representing the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy has aligned its guidance with other professional societies, including the United States Preventative Services Task Force (USPSTF) and the American Cancer Society.
“The MSTF made these determinations based upon evidence demonstrating an increasing incidence and mortality from CRC in individuals under age 50, with data suggesting that the yield of screening in 45-49-year-olds is similar to the yield of screening 50-59-year-olds, and that the benefits of screening in younger individuals outweigh the harms and costs based on modelling studies,” it said .
In advice on when to stop screening the MSTF advised that “individuals who are up to date with screening and have negative prior screening tests, particularly high-quality colonoscopy, consider stopping screening at age 75 years or when life expectancy is less than 10 years.
The updated guidelines are published in Gastroenterology.
Evidence backs ‘grow your own’ rural medical workforce
The first evidence has emerged to support a ‘grow your own’ rural workforce strategy of selecting doctors from and training them in specific rural regions that are underserviced by medical practitioners.
An analysis of data from more than 6627 doctors participating in the 2017 MABEL workforce survey showed that those who were selected and trained in a specific region of need were 17 more likely to continue working in the same rural region compared with doctors from cities and who spent only brief (< 12 week) duration in rural training.
The study also backed longer periods of rural training, showing that doctor were more than five times more likely to be retained in rural practice if they trained there for a year compared those who completed short periods of rural training.
“Reorienting medical training to selecting and training in specific rural regions where doctors are needed is likely to be an efficient means to correcting healthcare access inequalities,” the University of Queensland Rural Clinical School researchers said in the journal Human Resources for Health.