Coeliac disease is a long-term autoimmune disorder affecting the small intestine. Patients develop intolrence to gluten. Symptoms of Coeliac disease can range from mild to severe and be intermittent. Common symptoms include diarrhoea, abdominal pain, bloating, dyspepsia, along with fatigue, weight loss and a rash to name a few. It may also present with vitamin deficiencies and osteoporosis. Coeliac antibody testing along with biopsy of the duodenum at endoscopy are the standard ways to confirm a diagnosis of coeliac disease. Patients attending for upper gastrointestinal with symptoms of bloating as an indication often have a duodenal biopsy to exclude coeliac disease. 

We aimed to assess the findings at duodenal biopsy on patient endoscopied with the indication of abdominal bloating to assess presence of coleiac disease

A single centre, retrospective analysis 100 consequetive patients with bloating as in indication for gastroscopy from April 2024 at a hospital in North London was undertaken. A review of whether duodenal biopsies and its findings were scrutinized with data collected using the Medilogic endoscopy reporting tool, and the electronic patients record. 

60 of 100 patients with indication of bloating having a gastroscopy had duodenal biospies performed. 2/60 ( 3%) had evidence of coeliac disease on histology. One of the patients had a positive tissue transglutamase antibody as an indication for duodenal biopsy. The second patient had anaemia with bloating as an indication to biopsy the duodenum. 58/60 (97%) patients with bloating as an indication of duodenal biopsies had no evidence of coeliac disease.

From this study we do not advocate routine duodenal biopsy at gastroscopy for the sole indication of bloating unless accompanied by anaemia or a positive TTG antibody. This will help reduce cost per endoscopic procedure along with making the procedure more ‘greener’.