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Background and Aim: While European Society of Pediatric Gastroenterology Hepatology and Nutrition advocates a no‐biopsy pathway for the diagnosis of celiac disease (CeD) in children if IgA anti‐tissue transglutaminase antibody (anti‐tTG ab) titer is ≥10‐fold upper limit of normal (ULN) and have a positive IgA anti‐endomysial antibody (EMA); the data for anti‐tTG Ab titer‐based diagnosis of CeD in adults is still emerging. We planned to validate if IgA anti‐tTG Ab titer ≥10‐fold predicts villous abnormalities of modified Marsh grade ≥2 in Asian adult patients with CeD. Methods: We recruited 937 adult patients with positive anti‐tTG Ab from two databases, including AIIMS Celiac Clinic and Indian National Biorepository. The diagnosis of definite CeD was made on the basis of a positive anti‐tTG Ab and the presence of villous abnormalities of modified Marsh grade ≥2. Results: Of 937 adult patients with positive anti‐tTG Ab, 889 (91.2%) showed villous abnormalities of modified Marsh grade ≥2. Only 47.6% of 889 adults with CeD had anti‐ tTG Ab titers of ≥10‐fold. The positive predictive value (PPV) and specificity of anti tTG Ab titer ≥10‐fold for predicting modified Marsh grade ≥2 were 99.8% and 98%, respectively. At anti‐tTG Ab titer ≥11‐fold, specificity and PPV were 100% for predicting villous abnormalities of modified Marsh grade ≥2. Conclusions: Approximately 50% of adults with CeD may benefit from the no biopsy pathway, reducing the health burden and risks of gastroscopy/anesthesia. [ABSTRACT FROM AUTHOR]

Background and Aim: Celiac disease (CeD) has now become a global disease with a worldwide prevalence of 0.67%. Despite being a common disease, CeD is often not diagnosed and there is a significant delay in its diagnosis. We reviewed the impact of the delay in the diagnosis on the severity of manifestations of CeD. Methods: We reviewed clinical records of 726 consecutive patients with CeD from the Celiac Clinic database and the National Celiac Disease Consortium database. We extracted specific data including the demographics, symptoms at presentation, time of onset of symptoms, time to diagnosis from the onset of the symptoms, and relevant clinical data including fold‐rise in anti‐tissue transglutaminase antibody (IgA anti‐tTG Ab) and severity of villous and crypt abnormalities as assessed using modified Marsh classification. Results: The median duration between the onset of symptoms and the diagnosis of CeD was 27 months (interquartile range 12–60 months). A longer delay in the diagnosis of CeD from the onset of symptoms was associated with lower height for age, lower hemoglobin, higher fold rise in IgA Anti tTG titers, and higher severity of villous and crypt abnormalities. About 18% of patients presented with predominantly non‐gastrointestinal complaints and had a longer delay in the diagnosis of CeD. Conclusions: There is a significant delay in the diagnosis of CeD since the onset of its symptoms. The severity of celiac disease increases with increasing delay in its diagnosis. There is a need to keep a low threshold for the diagnosis of CeD in appropriate clinical settings. [ABSTRACT FROM AUTHOR]

This rapid realist review aims to explain how and why person‐centred care (PCC) in primary care works (or not) among others for people with low health literacy skills and for people with a diverse ethnic and socioeconomic background, and to construct a middle‐range programme theory (PT). Peered reviewed‐ and non‐peer‐reviewed literature (Jan 2013–Feb 2021) reporting on PCC in primary care was included. Selection and appraisal of documents were based on relevance and rigour according to the Realist And Meta‐narrative Evidence Syntheses: Evolving Standards (RAMESES) criteria. Data on context, mechanisms and outcomes (CMO) were extracted. Based on the extracted data, CMO configurations were identified per source publication. Configurations containing all three constructs (CMO) were included in the PT. The middle‐range PT demonstrates that healthcare professionals (HCPs) should be trained and equipped with the knowledge and skills to communicate effectively (i.e. in easy‐to‐understand words, emphatically, checking whether the patient understands everything, listening attentively) tailored to the wishes, needs and possibilities of the patient, which may lead to higher satisfaction. This way the patient will be more involved in the care process and in the shared decision‐making process, which may result in improved concordance, and an improved treatment approach. A respectful and empathic attitude of the HCP plays an important role in establishing a strong therapeutic relationship and improved health (system) outcomes. Together with a good accessibility of care for patients, setting up a personalised care plan with all involved parties may positively affect the self‐management skills of patients. Good collaboration within the team and between different domains is desirable to ensure good care coordination. The coherence of items related to PCC in primary care should be considered to better understand its effectiveness. [ABSTRACT FROM AUTHOR]