OC92 An audit of the diagnostic practices for suspected coeliac disease in paediatric patients at our institution compared to the 2020 ESPGHAN guidelines
<h3>Background</h3> The 2020 ESPGHAN guidelines<sup>1</sup> on the diagnosis of coeliac disease (CD) highlight the pathway to serological and histological diagnosis. Both biopsy and non-biopsy approaches rely on the patient consuming gluten throughout investigations.<sup>2</sup> At this institution, some individuals referred with positive coeliac antibodies had been advised to exclude dietary gluten prior to confirmed diagnosis. This could lead to reluctance in reintroducing gluten which in turn causes delays in diagnosis, inaccurate diagnosis, negative patient/family experiences and poor utilisation of specialist outpatient clinic time. <h3>Aim</h3> This audit aimed to compare current diagnostic and referral practice at our institution with the 2020 ESPGHAN guidelines for diagnosis of CD. The audit looked at the following objectives: Identify the number of referred patients that have been advised for gluten free diet (GFD) prior to formal diagnosis/exclusion of diagnosis Assess the duration from initial testing to confirmation or exclusion of diagnosis <h3>Method</h3> Patients undergoing investigation for CD between March 2023 and February 2024 were identified using a multisystem approach. Relevant data were extracted from online patient records to assess TTG levels, EMA positivity, whether on a GFD prior to diagnosis and whether they had an endoscopy. The collected data were then analysed to check if the diagnostic pathway followed the ESPGHAN guidelines. <h3>Results</h3> 66 patients were identified for inclusion in the audit, with a mean age of 9.5 yrs (range 2–17), 56% female (n=37). 65% of patients had at least one GI symptom (n=43) and the rest had no reported GI features despite having a raised initial TTG. Over 1 in 4 patients (n=18) were incorrectly advised to exclude dietary gluten prior to full investigation for CD. Additionally, one parent had put their child on a GFD without being advised to do so, precluding full investigation for CD without first reintroducing gluten to the diet for a number of weeks. When patients had prematurely started a GFD prior to confirmed diagnosis, time taken for diagnosis/exclusion of CD was on average 4 months longer than for patients on a gluten-containing diet throughout investigation. Importantly, a sixth of those who had initially been advised to go on a GFD were later confirmed not to have CD (n=3). 62% of patients were given a diagnosis of CD, however 12% of those did not strictly follow the guidelines for diagnosis (n=5). About 1/5 of those referred with raised TTG had a diagnosis of CD excluded following comprehensive investigation, 3% were expected to have latent CD, and 15% were still awaiting investigation results at the time of data analysis. <h3>Conclusion</h3> This audit showed over 90% adherence to ESPGHAN guidelines. Over 60% of patients with raised TTG had CD, however 2/3 of patients required histological confirmation. Over 1/4 of patients were wrongly advised to start a GFD prior to formal diagnosis. This resulted in an average delay in diagnosis of 4 months. Following this audit, the department worked to educate local GPs, through newsletters and practical meetings, on the need to continue consuming gluten pending full investigation. <h3>References</h3> Husby S, Koletzko S, Korponay-Szabó I, <i>et al</i>. European society paediatric gastroenterology, hepatology and nutrition guidelines for diagnosing coeliac disease 2020. <i>Journal of Pediatric Gastroenterology and Nutrition</i> 2020;<b>70</b>:141–156. https://doi.org/10.1097/MPG.0000000000002497 NICE CKS Coeliac Disease 2020, https://cks.nice.org.uk/topics/coeliac-disease/;
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