Coeliac disease (CD) affects 1% of the population, but 75% patients remain undiagnosed despite national guidelines for screening. Coeliac serology has shown to be under-used, performed in only 30% of patients with anaemia or suspected CD, leading to missed or delayed diagnoses. We sought to evaluate the role of a finger prick point of care test (POCT) that gives antibody results within 10 min in community pharmacies, which could potentially provide a unique opportunity to improve the detection of CD in primary care.Method
A prospective case finding study was performed in 6 community pharmacies across Sheffield over a 4 month period in 2016 using a POCT, Simtomax (IgA/IgG-deamidated gliadin peptide, Tillotts Pharma, Rheinfelden, Switzerland). Adults entering the pharmacies with symptoms suggestive of or risk factors for CD were consented for the study and tested with the POCT. Individuals with a positive test were referred for a gastroscopy with duodenal biopsies alongside conventional serology (IgA-endomysial and IgA-tissue transglutaminase antibodies). People with known CD, those on a gluten free diet or those who were investigated for CD previously were excluded. We recorded the uptake rate of the POCT and gastroscopies, and the CD detection rate.Results
Eight individuals who were approached already had a CD diagnosis and therefore did not enter the study. A total of 500 people were tested with the POCT (369 females, 73.8%; age range 18–87, median age 49), with a positive POCT rate of 7.2% (36/500). Two people declined a gastroscopy after they had a positive POCT result, and 7 did not attend their gastroscopy appointments. Twenty-seven positive subjects (75%) underwent a gastroscopy with duodenal biopsies and serology. Two individuals were diagnosed with CD based on positive serology and Marsh 3 villous atrophy, and another patient with potential CD based on positive serology, the presence of HLA DQ2 and self-reported gluten intolerance without villous atrophy. The POCT uptake rate was 63%.Conclusion
There was a good uptake rate of the POCT and gastroscopies, although the CD detection rate was lower than anticipated. This could be due to the fact that Sheffield has a CD tertiary centre, with a higher than average CD detection rate and existing caseload. This study should be trialled in lower prevalence areas to determine the full potential of this case finding approach. If this proves to be effective, allied healthcare professionals such as community pharmacists could potentially take on the role of coeliac case finding, provided that a robust pathway is set up for the onward management of the test results.Disclosure of Interest
M. Lau: None Declared, D. Sanders Conflict with: Professor Sanders has received educational research grants from Dr Schaer (a gluten-free food manufacturer) and Tillotts Pharma (producer of a point of care test for celiac disease) for investigator led studies. Dr Shaer and Tillott’s Pharma did not have any input in the study design, access to study data, interpretation of the findings or drafting of the manuscript.