The COVID-19 pandemic has prompted more paediatric gastroenterologists in Australia and New Zealand to adopt a non-biopsy coeliac disease (CD) diagnosis in eligible children.

An online questionnaire completed by 39 paediatric gastroenterologists in 2021 found 34 (87%) were currently practising non-biopsy diagnosis in their patients with most (76%) following the 2020 European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines [link here].

The guidelines say a non-biopsy approach is appropriate for children with anti-tissue transglutaminase IgA antibody (TGA-IgA) values ≥10 times the upper limit of normal with appropriate tests and positive endomysial antibodies (EMA-IgA) in a second serum sample.

According to a study published in the Journal of Paediatrics and Child Health [link here], about half (56%) of respondents were already using a non-biopsy protocol before the pandemic.

A further 26% started diagnosing no-biopsy CD during the pandemic.

“The majority of 34 respondents who utilised non-biopsy CD diagnosis criteria reported that such practice reduced the need for endoscopy (94%) and that it was supported by good evidence (88%),” the study said.

“Almost two thirds (62%) of respondents thought that non-biopsy CD diagnosis would reduce the waiting time for other children needing an endoscopy. Other supportive reasons related to the COVID-19 pandemic were also reported.”

The study did not explore the relationship between the impact of local endoscopy restrictions and the respondent’s decision to maintain or change their practice.

In keeping with the ESPGHAN guidelines, TTG-IgA was the most frequently ordered initial coeliac screening test for children of any age.

Deamidated gliadin peptide IgG antibody (DGP-IgG) was ordered by 59% of respondents for children >2 years of age and 69% for children ≤2 years of age while EMA was ordered by 41% of clinicians for children of all ages.

Full blood counts (95%), ferritin (95%) and total immunoglobulin A (92%) were also routinely ordered by respondents as part of their initial coeliac screening tests.

Most respondents said they would exclude patients with underlying comorbidities such as IgA deficiency (71%), type 1 diabetes (59%) and trisomy 21 (35%) from a non-biopsy CD diagnosis.

The study found that all respondents who practised biopsy-proven CD felt uncertain of the reliability of their local laboratory assays.

“Almost two-thirds of this group reported personal experience of false-positive results as a reason to not use non-biopsy protocols. One of these five responders felt there was insufficient evidence worldwide to support such practice.”

“Given that more Australasian physicians are now utilising non-biopsy CD diagnostic criteria, a consistent diagnostic approach and standardisation of coeliac serology assays across Australasia will be increasingly important,” it concluded.

The investigators represented the PEDiatric Australasian Gastroenterology Research NEtwork (PEDAGREE).