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Pre-endoscopic serological test with duodenal biopsy in high risk patients had high sensitivity and low specificity for coeliac disease

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 Q Does a clinical decision tool (CDT) based on pre-endoscopic serological testing with duodenal biopsy for high risk patients accurately diagnose coeliac disease?

Clinical impact ratings Gastroenterology ★★★★★☆☆ IM/Ambulatory care ★★★★★☆☆

METHODS

Embedded ImageDesign:

2 cohort studies, 1 for derivation and 1 for validation.

Embedded ImageSetting:

endoscopy department at the Royal Hallamshire Hospital, Sheffield, UK.

Embedded ImagePatients:

1464 patients in the retrospective derivation cohort and 2000 patients 16–94 years of age (mean age 56 y, 58% women) in the prospective validation cohort who were referred for gastroscopy. Exclusion criteria were previously known coeliac disease, coagulopathy (international normalised ratio >1.3 or platelets <80 x 109/l), active gastrointestinal bleeding, or suspected cancer.

Embedded ImageDescription of prediction guide:

the CDT combined pre-endoscopic serological testing (tissue transglutaminase [TTG] antibody) and assessment of symptoms to identify patients at high or low risk of coeliac disease. The CDT was modified in the validation …

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