Paediatric gastroenterologist perspectives and practice of coeliac disease diagnosis in Australasia before and during the COVID-19 pandemic

Abstract

Objectives and Study: This study aimed to explore the perceptions and practices of Australasian paediatric gastroenterologists in diagnosing coeliac disease (CeD) before and during the COVID-19 pandemic. Methods: All paediatric gastroenterologists and gastroenterology trainees in Australasia were invited via an existing email network to complete an anonymous online questionnaire over a two-week period. Ethics approval was obtained prior to commencement of the survey. Results: The questionnaire was completed by 45 respondents, including eight trainees: 41 from Australia and four from New Zealand. Of the 45 respondents, 38 (84%) reported they currently practised non-biopsy diagnosis of CeD in eligible children, and the rest diagnosed CeD with biopsy confirmation only. All New Zealand respondents practised non-biopsy CeD diagnosis. A majority of responders (82%) who practised non-biopsy CeD diagnosis reported using the 2020 European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines. Five (11%) respondents reported that their practice of diagnosing CeD was not impacted by the pandemic, 23 (51%) started diagnosing non-biopsy CeD before the pandemic and did not change their practice during the pandemic, 14 (31%) started diagnosing non-biopsy CeD during the pandemic, two (4%) began diagnosing patients having probably CeD when there was no access to endoscopy and intend to perform a gluten challenge with biopsy confirmation later, and one started training during the pandemic. Of the 14 respondents who started diagnosing non-biopsy CeD during the pandemic, three considered changing their non-biopsy CeD practice post-pandemic. Among the 38 respondents who practised non-biopsy CeD diagnosis, 36 (95%) reported such practice reduces the need for endoscopy in children, followed by (84%) good evidence to support such practice. For those seven respondents who only practice biopsy-proven CeD, lack of lab assay reliability (86%) was the most provided reason. Forty-one respondents agreed that paediatric gastroenterologists are experienced to diagnose CeD without biopsy, while two did not agree and one did not respond. When asked about which clinician should be permitted to diagnose non-biopsy CeD, 98% of the respondents stated paediatric gastroenterologist, 18% stated adult gastroenterologist, 13% stated general paediatrician, 2% stated general practitioner and 2% stated no-one. Conclusions: A majority of the Australasian gastroenterologist and trainee respondents reported routinely practising non-biopsy CeD diagnosis in eligible children; almost a third of them started nonbiopsy practice during the pandemic. 2020 ESPGHAN guidelines were the most used guidelines to diagnose non-biopsy CeD. A minority routinely rely on biopsy confirmation only to diagnose CeD.L6385442302022-07-29 <br />