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Introduction The current prevalence of Coeliac Disease (CD) in UK is said to be around 1 per 100 (1%) individuals[1,2]. For the last 10 years there has been a regional drive from our CCG to discharge confirmed coeliac patients back to their GPs for community based care. It often seems that we see these patients later on in their disease course, with complications that were potentially avoidable. Iron deficiency anaemia (IDA) is a common problem in CD, and is said to occur with a prevalence as high as 46% [1], whilst up to 8.7% of all unexplained IDA appears to be associated with CD [2]. Objective To assess the prevalence of IDA in our CD cohort, and the recurrence of IDA in these patients over a 7 year period. In those failing to correct (eg. with oral iron), we aimed to review the proportion that received intravenous (IV) iron. Method The Luton and Dunstable University Hospital serves a catchment of 3 30 000 and has a CD database of 1430 patients (0.43%), which is slightly lower than the 1% National prevalence rate. Over the last 7 years we have compiled a database documenting each occasion a patient has presented for blood tests and has had evidence of confirmed IDA. For the purposes of this study we defined iron deficiency anaemia as a haemoglobin level of Results Coeliac disease was found to be associated with 1.7% (967/54977) of all the IDA picked up over the 7 year review period. Conversely, 420 (or 29%) of our 1430 local CD patients were found to have IDA. 388 CD patients presented 967 times with IDA (an average of 2.5 times each, range 1–35 times). Of these 420 CD patients with IDA, just 4% (17/420) received an IV iron infusion. Conclusion Over a 7 year review period 29% of our CD cohort were found to have IDA. Despite tiredness and lethargy being the most common symptom CD patients complain of impacting on their daily lives, just 4% of these received IV iron supplementation. Many of these patients had presented on multiple occasions with IDA (average 2.5 times). Due to the previous CCG drive to discharge these patients back to their GPs for community based follow up, it is possible that these results show a failure in the community monitoring and management system. References . Bottaro G, Cataldo F, Rotolo N, Spina M, Corazza GR. The clinical pattern of subclinical/silent celiac disease: an analysis on 1026 consecutive cases. Am J Gastroenterol 1999; 94:691–696. . Hematologic manifestations of celiac disease. Thorvardur R. Halfdanarson, Mark R. Litzow and Joseph A. Murray. Blood 2007 109:412–421. Disclosure of Interest None Declared

Introduction Lower gastrointestinal (GI) endoscopy is frequently requested in patients with coeliac disease (CD) who present with a change in their bowel habit (CIBH), towards diarrhoea or “looser stools” (regardless of age, and often in the absence of other red-flag features such as weight-loss). This is primarily driven by the need to exclude microscopic colitis (MSC). There is, however, little evidence in the current literature to determine direct causation between CD and MSC, whilst the strength of the association is still not fully known. We set out to review the number of CD patients referred locally for lower gastrointestinal (GI) procedures, the primary referral reason and the outcomes. Method The Luton and Dunstable University Hospital has a database of 1317 patients with coeliac disease [Male n=467, Female n=850; Age range: 1–102 years old; mean age 58]. Using the database for reference, the hospital coding system was used to analyse the total number of lower GI endoscopy procedures performed for these patients during 2005–2016. Indications for the procedures were identified, along with their further histopathological analysis. Results Over the 12 year period, the 1317 patients underwent a total of 527 lower GI procedures; 413 colonoscopies, 108 flexible sigmoidoscopies and 6 pouchoscopies. These were performed for the following primary indications: 252 for CIBH (reflecting diarrhoea/loose stools); 53 for rectal bleeding; 52 for the Bowel Cancer Screening Programme; 54 for concomitant inflammatory bowel disease (IBD) assessment; 48 for anaemia; 21 for abnormal radiology; 15 post-cancer resection reviews; 9 for abdominal pain and 23 others. MSC was found in just 4 patients presenting with CIBH (4/252, 1.6%). Other findings included 20 new lower GI malignancies (1 with CIBH), 26 new cases of IBD (16 with CIBH), and 101 with melanosis coli (97 for CIBH, 3 for rectal bleeding and 1 for anaemia). Conclusion 48% of the lower GI procedures performed in CD patients were due to CIBH, and MSC was only found in 4 of these patients, suggesting a weak association. Melanosis coli was histologically identified in 38.5% of procedures performed for CIBH. We know constipation is a common symptom in CD and melanosis coli is often attributed to use of laxatives, however a direct pathological link between CD and melanosis coli cannot be excluded. Consultations relating to CIBH in CD patients should focus on constipation and use of laxatives, however, the role of calprotectin +/- endoscopy remains crucial, given the number of new cases of colorectal cancer (20, 4%) and IBD (26, 5%) identified in our CD cohort. Disclosure of Interest None Declared

Introduction Due to financial pressures within the NHS, many CCG’s have recently decommissioned gluten-free prescriptions for coeliac disease (CD) patients. Unfortunately, the true financial impact of coeliac disease on the NHS, has never been fully understood. In order to protect the care of CD patients in our local catchment, we sort to understand the existing burden of care of these patients, particularly on the hospital admission system, through daycase procedures and direct inpatient stay. Method The Luton and Dunstable University Hospital has a database of 1317 patients with coeliac disease [Male n=467, Female n=850; Age range: 1–102 years old; mean age 58; current paediatric patients (age ≤16) n=61]. Using this database for reference, the hospital coding system was used to analyse the total number of inpatient (stay) and day-case admissions between 2005–2016, and identify the admitting specialties. Results For the 1317 coeliac patients, there were 1267 inpatient admissions. The number of inpatient admissions per patient (all ages) ranged from 0–51. The length of inpatient stay ranged from 1–64 days, with a total 5018 days spent within hospital, at an average 3.96 days per inpatient stay. Patients were admitted under a range of different specialities; general medicine n=556; paediatrics n=384; general surgery n=181; trauma and orthopaedics n=76; Obstetrics and Gynaecology (O and G) n=35; ear, nose and throat n=13; maxillofacial surgery n=13; urology n=9. There were 698 daycases involving the CD patients: the top 3 ranking specialties included dermatology n=124; O and G n=91, and ophthalmology n=88. Conclusion A total 1965 hospital admissions were attained by CD patients over 12 years (163.75 admissions/year), accounting for a total 5716 days spent within the hospital setting. On average, each patient had a mean of 1.49 hospital admissions. In total, 30% of all the CD inpatient admissions were seen in paediatric patients, highlighting its importance in the health of these younger patients. A surprisingly high number of cataract operations (74) were performed in these CD patients (independent of age) raising the possibility of a link. 24 miscarriages and 2 ectopic pregnancies were also documented, suggesting that CD may have a more important role in fertility and fecundity than previously thought. The role of coeliac disease within fertility may be underestimated. Not all the hospital admissions were directly related to underlying coeliac disease, but there clearly appears to be an increased demand placed on the local hospital admission services from these patients. Disclosure of Interest None Declared

Introduction Coeliac disease remains a huge burden on the NHS with an incidence of 1 in 100 people. For the last 10 years there has been a drive from our CCG to discharge patients with confirmed coeliac disease back to their GP’s for community based management. In this study, we set about establishing the total cost and demand made on the Luton and Dunstable District General Hospital in managing these coeliac patients, despite this policy. Main objective: To assess the demand and the cost of outpatient services provided to patients with coeliac disease, and to understand what outpatient services were being utilised. Method Luton and Dunstable Hospital has a database of 1317 patients with a diagnosis of coeliac disease. Using the hospital’s coding system we were able to analyse the total number of outpatient appointments (OPAs) made over 11 years between 2005 and 2016. Total costs were calculated using a range of different prices for different specialties, and depending on whether the OPAs were new (£210-£265) or follow up (£83-£136) clinic appointments. In addition, the burden on certain specialties was analysed in more detail. Results Over the 11 year period, 33 150 outpatient appointments were made by the 1317 coeliac patients (25.17 per person; 2.29 per person per year) costing the local trust a total of £5,167,396. The total number of appointments per patient ranged from 1 to 167. Including paediatrics, there were 3,235 Gastroenterology appointments made (836 new and 2399 follow-up) costing a total of £4 62 858. There were also 1468 appointments made with the dietitians (473 new and 995 follow-up) costing a total of £2 22 024 and 949 OPAs made with the Dermatology team (356 new and 592 follow-up) costing a total of £1 49 848. Interestingly, there were also 1451 OPAs made with the Ophthalmology team and 906 appointments made with the Audiology team. Conclusion Over 11 years, the 1317 patients made 33,150 OPAs, 10.25% of which were with the Gastroenterology team. The total cost of OPAs with specialties other than Gastroenterology was £4,704,538, however a large proportion of this cost, including Dietetic and Dermatology appointments, were likely to be related to the coeliac burden. In addition, with the established link between coeliac disease and ophthalmological manifestations secondary to associated autoimmune disease and nutritional deficiency, the burden of Ophthalmology OPAs was high in this group. Finally, there was also an unexpectedly high number of Audiology OPAs raising the suspicion that extra-intestinal manifestations of coeliac disease may be contributory. There is little in the literature regarding the auditory sequelae of coeliac disease, so further work in this area is needed. Disclosure of Interest None Declared