Wl White

The Role of an IgA/IgG-Deamidated Gliadin Peptide Point-of-Care Test in Predicting Persistent Villous Atrophy in Patients With Celiac Disease on a Gluten-Free Diet

Objectives:Mucosal healing is important in celiac disease (CD) for the prevention of complications. However, obtaining duodenal biopsies is invasive, and there is currently no reliable surrogate marker for histological remission in clinical practice. We aimed to assess the role of a point-of-care test (POCT) based on IgA/IgG-deamidated gliadin peptide, in detecting persistent villous atrophy (VA) in CD.Methods:We prospectively recruited patients with CD attending endoscopy for the assessment of histological remission. All patients had IgA-endomysial (EMA) antibodies, IgA-tissue transglutaminase (TTG) antibodies, and the POCT performed, and completed a validated dietary adherence questionnaire. A gastroscopy was performed in all patients, with four biopsies taken from the second part of the duodenum and one from the duodenal bulb. We compared the diagnostic performance of the surrogate markers against duodenal histology as the reference standard.Results:A total of 217 patients with CD (70% female, age range 16–83 years, median age 53 years) on a gluten-free diet (median duration 6 years) were recruited from 2013 to 2017. Eighty-five (39.2%) patients had persistent VA. The sensitivities of the POCT, TTG, EMA, and the adherence score in detecting VA were 67.1%, 44.7%, 37.7%, and 24.7% respectively (P=0.0005). The combination of the POCT and adherence score only marginally increased the sensitivity to 70.6% (59.7–80.0%).Conclusions:The sensitivity of the POCT was higher than the other surrogate markers in predicting VA. A POCT may provide the additional advantage of an immediate objective assessment of mucosal healing at the time of an office-based follow-up consultation.

Office-Based Point of Care Testing (IgA/IgG-Deamidated Gliadin Peptide) for Celiac Disease

OBJECTIVES: Celiac disease (CD) is common yet under‐detected. A point of care test (POCT) may improve CD detection. We aimed to assess the diagnostic performance of an IgA/IgG‐deamidated gliadin peptide (DGP)‐based POCT for CD detection, patient acceptability, and inter‐observer variability of the POCT results. METHODS: From 2013‐2017, we prospectively recruited patients referred to secondary care with gastrointestinal symptoms, anemia and/or weight loss (group 1); and patients with self‐reported gluten sensitivity with unknown CD status (group 2). All patients had concurrent POCT, IgA‐tissue transglutaminase (IgA‐TTG), IgA‐endomysial antibodies (IgA‐EMA), total IgA levels, and duodenal biopsies. Five hundred patients completed acceptability questionnaires, and inter‐observer variability of the POCT results was compared among five clinical staff for 400 cases. RESULTS: Group 1: 1000 patients, 58.5% female, age 16‐91, median age 57. Forty‐one patients (4.1%) were diagnosed with CD. The sensitivities of the POCT, IgA‐TTG, and IgA‐EMA were 82.9, 78.1, and 70.7%; the specificities were 85.4, 96.3, and 99.8%. Group 2: 61 patients, 83% female; age 17‐73, median age 35. The POCT had 100% sensitivity and negative predictive value in detecting CD in group 2. Most patients preferred the POCT to venepuncture (90.4% vs. 2.8%). There was good inter‐observer agreement on the POCT results with a Fleiss Kappa coefficient of 0.895. CONCLUSIONS: The POCT had comparable sensitivities to serology, and correctly identified all CD cases in a gluten sensitive cohort. However, its low specificity may increase unnecessary investigations. Despite its advantage of convenience and rapid results, it may not add significant value to case finding in an office‐based setting.

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 AIMS Coeliac 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. METHOD All 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. RESULTS Two 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%, p = .0005). 9/10 individuals undertaking magnification endoscopy training correctly identified all cases of villous atrophy. CONCLUSION Magnification 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 10 min. 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.

PTU-156 Cost and availability of gluten-free foods in the uk: in store and online

Introduction Coeliac Disease (CD) is an autoimmune condition of the small bowel. A gluten-free (GF) diet is the only treatment for CD and with increasing incidence,1the demand for GF food has increased. Prior studies show GF food is more expensive and high street availability is limited.2However this has not been assessed for online GFD. We aimed to assess the availability and cost of GF foods across a range of supermarkets in a single UK city (Sheffield). We also aimed to assess the impact online retailers had on the GF food market. Method 67 supermarkets were analysed, including a range of categories, sizes and locations. The total number of GF items which were on sale was counted and 10 items were selected to represent a range of commonly bought GF foods for which the price and availability was recorded. Where any were found, the price of their gluten-containing counterpart was also recorded. The same factors were then used to assess online retailers. Results Of the 67 supermarkets visited, 27 (40.3%) stocked no GF items, with the remaining 40 (59.7%) stocking at least one. The mean number of GF items sold per store was 30, but this varied greatly by store category and size. None of the budget or corner supermarkets surveyed stocked any GF items. Regular and luxury supermarkets had a greater range (p < 0.0001), stocking 37 and 55 items on average respectively, as did larger supermarkets in general (p < 0.0001). In terms of the ten items specifically surveyed, 31 (46.3%) stores stocked none of the items, with the remaining 36 (53.7%) stocking at least one. Stores that stocked GF food had a median of 8 of the 10 specific items available. Overall, GF items cost significantly more than their gluten-containing counterparts, with GF items costing on average 4.1 times more (p < 0.0001). All 21 online stores surveyed sold at least one GF item. The average number of GF items sold was 609, compared with 30 for stores (p < 0.001). The proportion of highlighted items sold was also significantly higher, with an average of 73.3% sold (p < 0.001). Despite a larger range, the average cost of GF items online was higher than in stores. Conclusion The availability of GF food in budget supermarkets and corner shops is lacking and GF food remains significantly more expensive. The greatest availability is online and in larger regular/luxury supermarkets. The issue remains that this could prevent lower socioeconomic groups from fully adhering to a GF diet. Disclosure of interest M. Burden: None Declared, P. Mooney: None Declared, R. Blanshard: None Declared, W. White: None Declared, D. Cambray-Deakin: None Declared, D. Sanders Consultant for: Has received funding from Dr Schar a gluten free food manufacturer for investigator led studies into coeliac disease. References West J, et al. Incidence and prevalence of celiac disease and dermatitis herpetiformis in the UK over two decades: Population-Based study. Am J Gastroenterol. 2014;109:757–768 Singh J, Whelan K. Limited availability and higher cost of gluten-free foods. J Hum Nutr Diet 2011;24:479–486