Number of biopsies?(same results for Ser+ and Ser=unknown) 4 ≥5 10 7.5 5 2.5 0 Biopsies
Which sites-suspected CD (almost same results for Ser+ and Ser=unknown) D1 D2 Beyond D2 Oesophagus Gastric Antral Body15129630 Pos ser Unknown ser
Routine CLO-suspected CD(same results for Ser+ and Ser=unknown) (if unknown: 5(not 4) would talke a CLO-test) Yes No 15 12 9 6 3 0 CLO
Endoscopy of patients with suspected coeliac disease,with known pos serology: Do you order any other tests? Giardia, n=1 No, n=7 [may order other tests when the diagnosis is conﬁrmed) Hp-test, n=1 Depends on patient’s symptoms and the mucosal aspects.
Endoscopy of patients with suspected coeliac disease,with unknown serology: Do you order any other tests? HLA, n=1 Hp, n=1 [according to mucosal appearance] SIBO, n=1 Serology, n=4 Nothing (No), n=4
Do you have review meetings with the pathologist? Yes No weekly, n=8 15 monthly, n=2 12 9 6 3 0 meetings w path
Do you as a clinician review the path slides? sometimes always never 15 12 9 6 3 0 meetings w path
Who performs the biopsy interpretations? pathologist Other 15 12 9 6 3 0 interpretation
Do you tell the pathologist Do you tell the pathologistthe serology status if known? other clinical data? yes no yes no 15 15 12 12 9 9 6 6 3 3 0 0 serology status clinical data
Agreed with pathologistabout classiﬁcation? yes no 15 12 9 6 3 0 is it possible to agree with a pathologist....?
Use the Marsh? (Marsh or Marsh-Oberh, n=12) if no, What classiﬁcations? yes no Stand Marsh, n=115 Marsh-Oberhuber, n=5 Corazza-Villan, n=212 Italian IAP VIllan, n=09 Other, n=7630 Descriptive, n=2 Marsh
Does your hospital have a If a standardized report isstandardized histo report/ missing, would you like one?checklist? yes no yes no 15 15 12 12 9 9 6 6 3 3 0 0 checklist Would you like a checklist?
Which features are important tostate in the histo report?
Routine use of when do you useimmunohistochemistry immunohistochemistry? yes no borderlne cases only if increased Other 15 15 12 12 9 9 6 6 3 3 0 0 immunohistoch when immunohistoch?
Do you get a purely histopathIELs, what is the norm? report? 20 25 Other yes no 15 15 12 12 9 9 6 6 3 3 0 0 IELs purely histoNormal histo, pathologist recommends serolgy: 11/16 yes
Are the new ESPGHAN criteria accepted in yourcountry? yes no15129630 Marsh
What serology do you use? antigliadin anti-TG2 anti-DGP EMA, IgA EMA, IgG Other 15 12 9 6 3 0 serology test
Best marker of dietary Asymptomatic patient withadherence? sero+ and VA symptom relief No need follow GFD antiobdy seroconversion Start GFD histo recovery Start GFD, follow-up with sero only Other Start GFD, follow-up with sero and histo15 1512 129 96 63 30 0 Marker-adherence what do we do?Consider all the above, n=2
Persistent VA inasymptomatic patients onGFD is no concern? strongly agree Agree Neither agree/disagree Strongly disagree15129630 Marker-adherence
In the deﬁnition of refractoryCD which of the followingare signs of malabsorption? iron deﬁciency folate deﬁciency osteoporosis bloating, abd pain, diarrhea*15129 Of those responding6 bloating etc, 2 indicated that these3 were symptoms that responded to dietary0 ﬁbre exclusion Marker-adherence
TTG+ patient with VA after12 months despite dietaryadherence, what do youconsider? steroids repeat biopsy (ﬂow cytometry, immunohistoch, TCR clonal) Watch longer assume residual gluten (food diary etc) Trial liquid/elemental diet15129630 what to do?
Patient with severe subtotalVA on diagnostic biopsy always have symptoms always have detectable nutritional deﬁciencies can be entirely asymptomatic always sero+15129630 what to do?
A patient with exceptionally (and unquestionably) goodgluten free dietary compliance (on a ‘supersensitive diet –excluding all codex wheat products and barley malt extract)has persisting sub total villous atrophy on repeat biopsy at 12months and 24 months, but was asymptomatic at presentationand follow up with normal weight and blood tests. A TTGtitre of 120 normalised to 2 after 6 months on diet and haspersisted at this low level... no concern15 not constitute RCD should be considered histologically refractory (+ c12 steroid trial steroids and/or azathioprine9630 what to do?
If you endoscope for other clinicians do you get thereport sent directly to them for their attention? or do yousee this and act on it? Example 2: If this is not yourpatient does the requesting physician have thisresponsibility? Requesting physician (Yes), n=8 Sometimes (both my and their responsibility), n=2 My responsibility, n=1-2
If you endoscope for other clinicians do you get the reportsent directly to them for their attention? or do you see thisand act on it? Example 3: How do you investigate thesepatients if serology for coeliac disease is negative? HLA, n=5 Hp, n=4 (CLO or fecal antigen) Parasites, N=1 NSAID’s history, n=1 IgA levels; n=2 Review the slides myself
When do you useimmunocytochemistry?Refractory, n=3Problematic cases, n=1
Best marker of response totreatment with GFDConsider all together, n=2Combine clinics and serology, n=1