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. 2025 Aug 5;12(1):e001900.
doi: 10.1136/bmjgast-2025-001900.

Nationwide survey of coeliac disease serology testing in the UK

Albin Alex  1 , Alex S Hong  2 , Marcus Dimmock  1 , Mohammad I Zaman  1 , Mohamed Adam  1 , Graeme Wild  3 , Hugo A Penny  4 , David S Sanders  4 , Penny Whiting  5 , Martha M C Elwenspoek  5 , Mohamed G Shiha  6 ; CD No-biopsy Study Group
Collaborators, Affiliations

Nationwide survey of coeliac disease serology testing in the UK

Albin Alex et al. BMJ Open Gastroenterol. .

Abstract

Objective: Recent evidence supports diagnosing coeliac disease without biopsy in patients with significantly elevated tissue transglutaminase (IgA-tTG) antibodies. However, the implementation of this no-biopsy approach relies on accurate and consistent serological testing across laboratories. In this nationwide survey, we aimed to evaluate the availability and variability of coeliac disease testing across the UK.

Methods: We conducted a cross-sectional telephone survey of biomedical scientists and laboratory managers from National Health Service trusts and health boards across England, Wales, Scotland, and Northern Ireland. Data collected included assay types, reporting methods, upper limit of normal (ULN) thresholds, turnaround times, total IgA testing, and anti-endomysial antibodies (EMAs) availability.

Results: A total of 356 sites were approached, with a 96% response rate (n=342). Of responding sites, 177 performed coeliac serology tests in-house, while 165 transferred samples externally. Among sites performing tests, 12 different IgA-tTG assays were identified, with considerable variability in ULN thresholds ranging from 3 to 30 IU/mL, even within laboratories using the same assays. The median turnaround time for IgA-tTG results was 7 days (range 1-21 days). Only 43% of laboratories routinely measured total IgA when IgA-tTG was requested. EMA testing was available in 83% of laboratories.

Conclusion: Significant variability exists in coeliac serology testing across UK laboratories which poses a challenge for the implementation of the no-biopsy approach in clinical practice. Efforts to standardise serological testing are urgently needed. Until such standardisation is achieved, local assay validation remains critical.

Keywords: CELIAC DISEASE; SMALL BOWEL; SMALL BOWEL DISEASE.

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Conflict of interest statement

Competing interests: MGS and HAP received speaker fees from Thermo Fisher. The other authors declare no competing interests.

Figures

Figure 1
Figure 1. Study flowchart. NHS, National Health Service.
Figure 2
Figure 2. The number of sites using each commercial assay for tissue transglutaminase (tTG) testing.
Figure 3
Figure 3. Variations in the upper limit of normal of IgA-tTG across different sites. IgA-tTG, IgA tissue transglutaminase.
Figure 4
Figure 4. Variations in turnaround time of IgA-tTG across different sites. IgA-tTG, IgA tissue transglutaminase.
See this image and copyright information in PMC

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