M Burden

High definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy.

BACKGROUND AND AIMSnCeliac disease remains underdiagnosed at endoscopy. We aimed to assess the utility of I-Scan (virtual chromo-endoscopy) to improve sensitivity of endoscopy to detect markers of villous atrophy in this condition.nnnMETHODSnPatients from 2 UK hospitals were studied in 3 groups. Group 1: standard high definition, white light endoscopy (WLE); Group 2: WLE plus I-Scan; Group 3: non-high definition control group. The presence of endoscopic markers was recorded. At least 4 duodenal biopsies were taken from all patients. Serology was performed concurrently and observations were compared with histology.nnnRESULTSn758 patients (62% female, mean age 52) were recruited (Group 1: 230; Group 2: 228; Group 3: 300). 135 (17.8%) new diagnoses of coeliac disease were made (21 Group 1; 24 Group 2; 89 Group 3). The sensitivity for detection of endoscopic markers of villous atrophy was significantly higher in both Group 1 (85.7%, p=0.0004) and Group 2 (75%, p=0.005) compared to non-high definition controls (41.6%). There was no significant difference between high definition only and I-Scan groups (p=0.47). In non-high definition endoscopy a missed diagnosis was associated with lesser degrees of villous atrophy (p=0.019) and low tTG titre (p=0.007).nnnCONCLUSIONSnHigh definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy.

Devising regional trainee initiatives to promote research.

s showed that 37 (33%) abstracts had been published in full in peer-reviewed journals and 75 had either never been completed or had remained in abstract form. Of the 32 abstracts placed in the top three presentations at their respective meetings, 24 (75%) had been published, as had 13 (16%) of the 80 which had not been ranked in the top three (p < 0.0001). The median impact factor of the journals in which the abstracts were published was 4.061 for the ranked group and 2.865 for the unranked group (Mann–Whitney test, p < 0.05). 532 a 2015 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 513–541 really good stuff

A comparison study between Magniview and high definition white light endoscopy in detecting villous atrophy and coeliac disease: A single centre pilot study

BACKGROUND AND AIMSnCoeliac disease may be missed at gastroscopy. We aimed to assess the sensitivity of Pentax optical zoom technology endoscopes in detecting duodenal villous atrophy and the ease of image interpretation by non-coeliac specialists.nnnMETHODnAll patients attending for a gastroscopy were assessed for endoscopic villous atrophy in part one and two of the duodenum with high definition white light endoscopy and magnification endoscopy. Endoscopic findings of the duodenum were compared to histology as the reference standard. A short training video of varying degrees of villous atrophy seen by magnification endoscopy was used to train individuals. They were then assessed for the ability to differentiate between normal duodenum and villous atrophy.nnnRESULTSnTwo hundred and fifty patients were prospectively recruited (145 females, 58%; age range 16-84, median age 50.5). Ninety-six patients had villous atrophy on histology (38.4%) 154 were controls. Magnification endoscopy had a higher sensitivity in detecting villous atrophy compared to high definition white light endoscopy (86.4% versus 78.4%, pu202f=u202f.0005). 9/10 individuals undertaking magnification endoscopy training correctly identified all cases of villous atrophy.nnnCONCLUSIONnMagnification endoscopy has superior diagnostic sensitivity in detecting villous atrophy compared to high definition white light endoscopy and the potential to be easily adopted by all endoscopists.

OC-040 A pre-endoscopy point of care test (iga/igg-deamidated gliadin peptide) as a case finding tool for coeliac diseasein secondary care

Introduction Coeliac disease (CD) is common yet underdiagnosed. 12.4% CD patients had a gastroscopy within 5 years without duodenal biopsies taken, and coeliac serology was performed in only 30% of patients with anaemia or suspected CD. A pre-endoscopy point of care test (POCT) could potentially fill this gap. We aimed to evaluate the diagnostic accuracy and acceptability of the POCT, Simtomax (IgA/IgG-deamidated gliadin peptide, Tillotts Pharma, Rheinfelden, Switzerland), in detecting CD. Method Group 1: Patients attending for a gastroscopy were prospectively recruited from 2013–17. We excluded patients with a high pre-test probability of CD: positive endomysial antibody (EMA) referrals, previous villous atrophy, self-reported gluten sensitivity, those on a gluten free diet (GFD), suspected gluten ataxia; and known CD. Group 2: Patients who self-reported gluten sensitivity were prospectively recruited. All patients underwent the POCT, tissue transglutaminase antibodies (TTG), EMA and duodenal biopsies. The sensitivities of the POCT were compared to TTG and EMA, measuring against histology as the reference standard. Questionnaires regarding patient preference to the modality of antibody testing were given out. Results Group 1: 1000 patients were recruited (585 females, 58.5%; age range 16–91, median age 57). Forty-one patients (4.1%) were diagnosed with CD. Group 1: Abstract OC-040 Table 1 Sensitivity (%) Specificity (%) PPV (%) NPV (%) POCT 82.9 (67.9–92.9) 85.4 (83.0–87.6) 19.5 (16.5–23.0) 99.2 (98.4–99.6) TTG 78.1 (62.4–89.4) 96.3 (94.8–97.4) 47.1 (38.3–56.0) 99.0 (98.3–99.5) EMA 70.7 (54.5–83.9) 99.8 (99.3–100.0) 93.6 (78.2–98.3) 98.8 (98.0–99.2) Group 2: Seventy patients who self-reported gluten sensitivity were recruited (51 females, 82.9%; age range 17–73, median age 35). Nine patients on a self-imposed GFD were excluded. Of the remaining 61 patients, 42 (68.9%) were diagnosed with non-coeliac gluten sensitivity (NCGS), 17 (27.9%) with CD and 2 (3.3%) with potential CD. Group 2: Abstract OC-040 Table 2 Sensitivity (%) Specificity (%) PPV (%) NPV (%) POCT 100 (82.4–100) 81.0 (65.9–91.4) 70.4 (56.0–81.6) 100 TTG 89.5 (66.9–98.7) 97.6 (87.4–99.9) 94.4 (70.9–99.2) 95.4 (84.7–98.7) EMA 84.2 (60.4–96.6) 97.6 (87.4–99.9) 94.1 (69.6–99.1) 93.2 (82.9–97.5) Five hundred patients responded to the POCT acceptability questionnaire. 90.8% preferred a POCT, 2.8% preferred venepuncture, and 6.8% had no preference. Conclusion The POCT had comparable diagnostic performance to conventional serology. It also correctly identified all cases of CD in a gluten sensitive cohort. The POCT could serve as a valuable and convenient case finding tool, with the advantage of providing antibody results rapidly at the point of endoscopy to target duodenal biopsy sampling for those with a positive POCT. Disclosure of Interest M. Lau: None Declared, P. Mooney: None Declared, W. White: None Declared, M. Rees: None Declared, M. Burden: None Declared, S. Wong: None Declared, M. Kurien: 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.

PTH-004 Magniview zoom endoscopy increases the detection of villous atrophy compared to high definition white light endoscopy

Introduction Coeliac disease (CD) is common yet under-diagnosed at endoscopy. The optical zoom technology of Pentax Magniview endoscopes can magnify images by 136 times. We aimed to assess the accuracy of Magniview in the detection of duodenal villous atrophy (VA), and the ease of interpretation of live zoomed-in images. Method Patients attending for a gastroscopy from 2014–17 were recruited. Endomysial (EMA) and tissue transglutaminase (TTG) antibodies were taken at endoscopy. Appearances of the first and second part of the duodenum (D1 and D2) observed with high definition white light endoscopy (HDWLE) and Magniview were graded on a 3-point scale validated by Cammarota et al.: normal, partial or marked villous atrophy (PVA, MVA). In all patients, quadrantic biopsies were taken from D2 and 1 biopsy from D1. Endoscopic findings of the duodenum were compared to histology as the reference standard. A short training video with 12 clips of normal duodenum and various grades of VA with Magniview was used to train medical staff to identify VA. They were assessed immediately after the training with 22 video clips for the ability to detect normal duodenum, PVA or MVA. Abstract PTH-004 Table 1 Sensitivity (%) Specificity (%) Positive Predictive Value (PPV) (%) Negative Predictive Value (NPV) (%) Magniview 86.4 (80.4–91.1) 74.4 (69.3–79.1) 64.7 (60.1–67.0) 90.9 (87.3–93.6) HDWLE 78.4 (71.6–84.2) 86.1 (81.9–89.7) 75.4 (69.8–80.3) 88.0 (84.7–90.7) TTG 74.8 (65.0–82.9) 94.0 (89.0–97.2) 89.2 (81.2–94.0) 85.0 (80.2–88.9) EMA 68.7 (58.6–77.6) 93.4 (88.2–96.8) 87.2 (78.6–92.6) 82.0 (77.2–86.0) Abstract PTH-004 Table 2 Endoscopists Role Sensitivity (%) Specificity (%) PPV (%) NPV (%) Consultant 62.5 64.3 50 75 Consultant 100 21.4 42.1 100 Registrar 100 28.6 44.4 100 Registrar 100 71.4 66.7 100 Registrar 100 85.7 80 100 Non-endoscopists Core medical trainee 100 50 53.3 100 Medical student 100 57.1 57.1 100 Medical student 100 35.7 47.1 100 Nurse 100 64.3 61.5 100 Nurse 100 35.7 47.1 100 Nurse 100 64.3 61.5 100 Results A total of 250 patients were recruited (145 females, 58%; age range 16–84, median age 50.5). Ninety-six patients had VA on histology (38.4%), of which 80 were newly diagnosed CD and 16 were persistent VA in known CD patients, leaving the remaining 154 as controls. Magniview had a significantly higher sensitivity in detecting VA compared to HDWLE (p=0.0005). (Table 1) Ten individuals (5 endoscopists and 5 non-endoscopists) undertook the Magniview training, and 9/10 correctly identified all cases of VA. (Table 2) Conclusion Magniview had superior diagnostic accuracy in detecting VA compared to HDWLE. A short training on the identification of VA with Magniview demonstrated its ease of use and suitability for Magniview to be utilised by general endoscopists in their daily practice to increase the detection of CD. Disclosure of Interest W. White: None Declared, M Lau: None Declared, P Mooney: None Declared, M Rees: None Declared, M Burden: 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.

OC-018 The role of a point of care test (iga/igg-deamidated gliadin peptide) in predicting histological remission in coeliac disease on a gluten free diet

Introduction Coeliac disease (CD) is a chronic inflammatory enteropathy treated with a gluten free diet (GFD). Non adherence can lead to symptoms and complications such as osteoporosis and malabsorption. Moreover, patients with persistent villous atrophy are twice as likely to develop lymphoproliferative malignancies compared to those who achieve mucosal healing. Therefore, the optimal assessment of treatment response is the evaluation of duodenal histology. However, there is little consensus in the UK on routine follow up biopsy. Duodenal biopsy requires a gastroscopy which is invasive and can be poorly tolerated. There is currently no reliable surrogate marker for histological remission in our daily clinical practice. We aimed to assess the role of a finger prick point of care test (POCT), Simtomax (IgA/IgG-deamidated gliadin peptide, Tillotts Pharma, Rheinfelden, Switzerland), in predicting histological remission in CD. Method We prospectively recruited patients with known CD attending for a gastroscopy with duodenal biopsy for the assessment of histological remission. IgA-endomysial antibodies (EMA), IgA-tissue transglutaminase antibodies (TTG), total IgA levels and the POCT were performed in all patients at endoscopy. Patients also completed a validated GFD adherence questionnaire devised by Biagi et al. which gives a 5 point score (0–4), with the highest score indicating strict dietary adherence. A gastroscopy was performed with quadrantic biopsies taken from the second part of the duodenum and one from the duodenal bulb. We compared all surrogate markers to the gold standard of duodenal histology. Sensitivity (%) Specificity (%) PPV (%) NPV (%) POCT 67.1 (56.0–76.9) 59.1 (50.2–67.6) 51.4 (45.0–57.6) 73.6 (66.6–79.6) TTG 44.7 (33.9–55.9) 86.4 (79.3–91.7) 67.9 (56.4–77.5) 70.8 (66.5–74.8) EMA 37.7 (27.4–48.8) 89.4 (82.9–94.1) 69.6 (56.5–80.1) 69.0 (65.1–72.6) Adherence score 24.7 (16.0–35.3) 86.4 (79.3–91.7) 53.9 (39.8–67.3) 64.0 (60.8–67.2) Results A total of 217 (70% female, age range 16–83, median age 53) patients with CD on a GFD (median duration 6 years) were recruited from 2013–2017. Eighty-five (39.2%) patients had persistent villous atrophy. The POCT was the most sensitive surrogate marker for predicting villous atrophy (p=0.0005). Conclusion Of all clinically available surrogate markers, the POCT was the most sensitive in predicting villous atrophy. The POCT has the additional advantage of convenience being a finger prick test, providing rapid results within 10u2009min. In combination with clinical and dietetic assessments, the POCT could aid clinical decision making on the necessity of follow-up duodenal biopsy within the same consultation. Disclosure of Interest M. Lau: None Declared, P. Mooney: None Declared, W. White: None Declared, M. Rees: None Declared, M. Burden: None Declared, S. Wong: 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.

OC-028 Does Duodenal Histology Yield any Other Diagnoses for Iron Deficiency Anaemia Apart From Coeliac Disease?

Introduction The prevalence of iron deficiency anaemia (IDA) is 2–5% in the developed world. The BSG IDA guidelines recommend screening for coeliac disease (CD) with serology, and those tested positive should undergo duodenal biopsy to assess for villous atrophy (VA). The availability of pre-endoscopy serology in IDA has been shown to be 30%, thus often committing clinicians to routinely biopsy the duodenum. We aimed to explore whether any causes other than CD would be found on duodenal biopsy in IDA. We also aimed to evaluate the role of Simtomax, an IgA/G-deamidated gliadin peptide based point of care test (POCT), in detecting CD in IDA in the endoscopy setting. Methods Group 1: we retrospectively reviewed the duodenal histology of 153 patients with IDA attending a non coeliac specialised IDA clinic in 2013–14. Group 2: we prospectively recruited 133 patients with iron deficiency attending for a gastroscopy to our research gastroscopy list. All patients undertook Simtomax, endomysial antibodies (EMA), tissue transglutaminase (TTG), total IgA, and 5 duodenal biopsies. The results were compared against histology. Results The duodenal histology in group 1 yielded no cause for the IDA apart from CD. Two patients had VA- 1 with positive serology and hence was diagnosed with CD; the other patient never had a serology to confirm the diagnosis as he subsequently died from colon cancer. Assuming the latter case to be CD, the prevalence of CD in this cohort would be 1.3%. 5/7 patients with lymphocytic duodenosis (LD) had a cause for or association with LD: vitiligo, autoimmune hypothyroidism, aspirin use, proton pump inhibitor use, and Helicobacter pylori infection respectively. No attributable causes for LD were found in the remaining 2 patients. In group 2, the prevalence of CD was 19.5%. The sensitivity and NPV of Simtomax were 100%.Abstract OC-028 Table 1 Gp1 Histology 153 Normal (Marsh 0) 141 (92.2%) LD (Marsh 1) 7 (4.6%) VA (Marsh 3 c) 2 (1.3%) Reactive changes, submucosal haemangioma, chronic duodenitis 1, 1, 1 Gp2 Sensitivity, % Specificity, % PPV, % NPV, % Simtomax 100 82.2 57.8 100 TTG 96.2 91.5 73.5 99.0 EMA 84.6 99.1 95.7 96.4 Conclusion Our duodenal histology review revealed no alternative causes for the IDA other than villous atrophy secondary to CD. Simtomax had 100% sensitivity and NPV for detecting CD in IDA. This suggests that performing a duodenal biopsy in patients with a negative Simtomax test is highly unlikely to yield a diagnosis for IDA, thus could be safely avoided if the sole purpose of the biopsy is to investigate IDA. Simtomax could provide significant cost savings by targeting patients with IDA who require a duodenal biopsy. Disclosure of Interest M. Lau: None Declared, P. Mooney: None Declared, W. White: None Declared, M. Burden: None Declared, S. Wong: None Declared, M. Kurien: None Declared, S. Cross: None Declared, J. Hebden: None Declared, D. Sanders Grant/research support from: Tillotts Pharma for investigator led studies in coeliac disease. None of the funding sources had any input in the study design, access to study data, interpretation of the findings or drafting of the abstract.

OC-024 Does the Point of Care Test, Simtomax, Distinguish between Coeliac Disease and Non-Coeliac Gluten Sensitivity?

Introduction Non coeliac gluten sensitivity (NCGS) is an emerging clinical entity with a prevalence of 0.5–13%. It is characterised by gluten related symptoms with a negative coeliac serology and no villous atrophy (VA). It is currently a diagnosis based on exclusion of coeliac disease (CD). We aimed to assess the role of Simtomax, an IgA/G deamidated gliadin peptide (DGP) based point of care test (POCT), in differentiating between NCGS and CD. Methods Group 1: we compared the sensitivities of 3 POCTs: Simtomax, Biocard [IgA-tissue transglutaminase (TTG)] and Celiac Quick Test (IgA/G/M-TTG). We prospectively recruited 100 patients referred with a positive endomysial antibody (EMA) attending for a gastroscopy. All patients undertook the 3 POCTs, EMA, TTG, and all underwent a gastroscopy with 5 duodenal biopsies. Sensitivities were measured based on their histology. Group 2: the sensitivity of Simtomax in the general population was evaluated by prospectively recruiting 667 patients with gastrointestinal symptoms or ataxia attending for a gastroscopy. To reduce positive ascertainment bias, we excluded patients referred with a positive EMA, previous VA, known CD, self-reported gluten sensitivity, and those on a gluten free diet. All patients undertook Simtomax, EMA, TTG and a gastroscopy with 5 duodenal biopsies. Sensitivities were measured based on their histology. Group 3: we demonstrated the sensitivities of Simtomax in a gluten sensitive population. 35 patients with self-reported gluten sensitivity attending for a gastroscopy were prospectively recruited. All patients undertook Simtomax, EMA, TTG and a gastroscopy with 5 duodenal biopsies. Sensitivities were measured based on their histology. Results Group 1 showed that Simtomax was the best POCT in detecting CD. The CD prevalence was 85%. In group 2, the sensitivity and negative predictive value (NPV) of Simtomax were comparable to that of EMA and TTG. The prevalence of CD was 4.95%. In group 3, Simtomax had 100% sensitivity and NPV in differentiating between CD and NCGS. 4 patients (11.4%) were diagnosed with CD, 4 (11.4%) with potential CD (positive serology but no VA) and 27 (77.1%) with NCGS (negative serology and no VA).Abstract OC-024 Table 1 Gp 1 Sensitivity, % Specificity, % PPV, % NPV, % Simtomax 96.5 6.67 85.4 25 Biocard 71.8 53.3 89.7 25.0 Celiac Quick Test 67.1 33.3 85.1 15.2 Gp 2Simtomax 78.8 85.0 21.5 98.7 EMA 72.7 99.5 88.9 98.6 TTG 75.8 93.1 36.2 98.7 Gp 3Simtomax 100 80.6 40.0 100 EMA 75.0 96.8 75.0 96.8 TTG 75.0 87.1 42.9 96.4 Conclusion Simtomax was the most accurate POCT for detecting CD. In a lower CD prevalence group 2 cohort, its sensitivity remained comparable to TTG and EMA. Simtomax had 100% sensitivity in detecting CD in patients with self-reported gluten sensitivity, and 100% NPV in identifying patients with NCGS. Disclosure of Interest M. Lau: None Declared, P. Mooney: None Declared, W. White: None Declared, M. Burden: None Declared, S. Wong: None Declared, M. Kurien: None Declared, D. Sanders Grant/research support from: Tillotts Pharma for investigator led studies in coeliac disease. None of the funding sources had any input in the study design, access to study data, interpretation of the findings or drafting of the abstract.

PWE-058 The Role of A Point of Care Test, Simtomax, in Predicting Histological Remission in Coeliac Disease on A Gluten Free Diet: Abstract PWE-058 Table 1

Introduction Coeliac disease (CD) is a chronic inflammatory enteropathy treated with a gluten free diet (GFD). Clinical symptoms and complications of CD are thought to be associated with ongoing duodenal inflammation due to continued gluten exposure, hence the optimal assessment of response to a GFD is histological remission. However, there is little consensus in the UK on routine re-biopsy during follow up. Duodenal biopsy requires a gastroscopy which is invasive and can be poorly tolerated. Coeliac serology and dietetic evaluation have been used as surrogate markers for histological remission, but the correlation has been shown to be poor. We aimed to assess the role of an IgA/G-deamidated gliadin peptide (DGP) based point of care test (POCT), Simtomax, in predicting histological remission in CD. Methods We prospectively recruited patients with known CD attending for a gastroscopy with duodenal biopsy for the assessment of disease remission. All patients underwent a blood test for IgA-endomysial antibodies (EMA), IgA-tissue transglutaminase antibodies (TTG), total IgA levels and Simtomax at the point of endoscopy. They also completed a validated GFD adherence questionnaire (Biagi) which gives a 5 point score (0–4), with the highest score indicating strict adherence to a GFD. Patients with an adherence score of 3 or 4 were considered to follow a strict GFD. A gastroscopy was then performed with quadrantic biopsies taken from the second part of the duodenum and one biopsy taken from the duodenal bulb. We compared all surrogate markers to the gold standard of duodenal histology. Results 145 (74% female, median age 53) patients with CD on a GFD were recruited from 2013–2015. 52 (36%) patients had persistent villous atrophy. Simtomax was the most sensitive in predicting villous atrophy (78.8%). The sensitivities of EMA, TTG and the GFD adherence score were significantly lower than that of Simtomax. Simtomax had the best negative predictive value (NPV) for villous atrophy at 82.5%.Abstract PWE-058 Table 1 Surrogate marker Sensitivity (%) Specificity (%) PPV (%) NPV (%) Simtomax 78.8 (78.5–79.2) 55.9 (55.6–56.2) 50 (49.7–50.3) 82.5 (82.2–82.8) TTG 51.9 (51.5–52.4) 80.6 (80.4–80.9) 60 (59.5–60.5) 75 (74.7–75.2) EMA 36.5 (36.1–37.0) 83.9 (83.6–84.1) 55.9 (55.3–56.4) 70.3 (70.0–70.5) Adherence score 23.1 (22.7–23.4) 82.8 (82.6–83.0) 42.9 (42.3–43.4) 65.8 (65.5–66.1) Conclusion Simtomax exceeds all other available surrogate markers in predicting the presence of villous atrophy. Simtomax could be used to aid informed decision making in patients who require but are reluctant to undertake a gastroscopy for duodenal biopsy to assess for disease remission. It could also act as a useful adjunct to identify patients who may require further dietetic support. Disclosure of Interest M. Lau: None Declared, P. Mooney: None Declared, W. White: None Declared, M. Burden: None Declared, S. Wong: None Declared, M. Kurien: None Declared, D. Sanders Grant/research support from: Tillotts Pharma for investigator led studies in coeliac disease. None of the funding sources had any input in the study design, access to study data, interpretation of the findings or drafting of the abstract.

PTH-176 Predicting histological remission in patients with coeliac disease on a gluten free diet: Abstract PTH-176 Table 1

Introduction Up to 30% of patients with celiac disease (CD) will have persistent symptoms despite the introduction of a gluten free diet (GFD). Assessment of adherence in celiac disease can involve any combination of patient self-reporting adherence, dietetic assessment, serology and biopsy with histology. Histology is considered to be the ‘gold standard’ but this requires a repeat endoscopic examination with its associated risks and problems with tolerance. As a result surrogate markers of persistent gluten exposure and histological changes such as serology are frequently used but the relationship between serology and persistent histological changes is not linear. A structured interview with a dietician has been shown to be the most accurate method of assessing GFD adherence however this is time consuming and requires extra clinic visits. The aim of this study was to assess the usefulness of two novel options. Firstly a previously internally validated scoring system for assessing GFD adherence (which has never been externally validated) and secondly a rapid deamidated gliadin peptide based point of care test (POCT, Simtomax) for the prediction of persistent villous atrophy (VA). Method All patients with known CD and persistent symptoms coming to a specialist CD endoscopy list for the re-assessment of histology were invited to take part. All patients were tested for Endomysial Antibody (EMA), tissue transglutaminase (tTG), immunoglobulins and the POCT. They were also asked to complete a questionnaire to calculate a 5 point score (0–4) with a high score representative of improved adherence to a gluten free diet. All patients underwent gastroscopy with at least 4 biopsies from the second part of the duodenum and 1 to 2 biopsies from the bulb. Results 94 patients (77% female, mean age 52.6) were recruited between April 2013 and December 2014. Median duration of GFD was 84 months (range 6–768). 36 (38.3%) patients had persistent VA on duodenal biopsy. The POCT was the most sensitive marker with 63.4% of patients with VA having a positive test. EMA was the most specific surrogate marker at 82.8% although it was highly insensitive with only 33.0% of patients with VA having a positive EMA. The adherence score could not be reliably used to predict VA with a sensitivity of only 30.6%. Conclusion An accurate surrogate marker for VA could reduce the number of endoscopies required. In this cohort the POCT had the best sensitivity, detecting 23/36 (63.4%) cases of villous atrophy, however this is pilot data and further work is required. It may be that additive methods for assessing adherence could achieve 100% sensitivity.Abstract PTH-176 Table 1 Measure Sensitivity (%) Specificity (%) PPV (%) NPV (%) Adherence Score 30.6 79.3 47.8 64.8 tTG 50.0 75.9 56.3 37.9 EMA 33.0 82.8 54.5 66.7 POCT 63.4 60.3 50.0 72.9 Disclosure of interest P. Mooney: None Declared, S. Wong: None Declared, M. Kurien: None Declared, M. Burden: None Declared, D. Sanders Grant/ Research Support from: Received research grants from BHR Pharmaceuticals and Tillotts Pharma for investigator led studies into coeliac disease.