Exploring the views of primary and secondary care physicians on the no-biopsy diagnosis of coeliac disease in adults: a qualitative interview study

Objective: Despite mounting evidence supporting a no-biopsy approach for the diagnosis of coeliac disease in adults, established clinical pathways in primary and secondary care could hinder implementation in clinical practice. We aimed to identify the barriers and facilitators to a no-biopsy diagnostic pathway of coeliac disease in primary and secondary care.

Methods: We conducted a qualitative study using semistructured interviews with gastroenterologists and general practitioners (GPs). We used a predefined interview topic guide consisting of open-ended questions and prompts to facilitate discussion about the views of primary and secondary care physicians on the no-biopsy diagnosis of coeliac disease in adults.

Results: We interviewed 24 physicians (12 gastroenterologists and 12 GPs) across England between February and March 2024. Participants had different levels of experience ranging between 2 years and 30 years. Gastroenterologists were more familiar with the no-biopsy approach and the evidence supporting it compared with GPs. Both groups were supportive of the no-biopsy approach but acknowledged the lack of clear guidelines as a major barrier to implementation in clinical practice. Increased patient satisfaction, shorter waiting times to start treatment and reduced endoscopy service pressures and costs were perceived as the main advantages of the no-biopsy approach. However, participants had concerns regarding false-positive results, missing concurrent pathology, dealing with persistent symptoms after treatment without biopsy confirmation and the increased workload in primary care.

Conclusion: The safe and effective implementation of this no-biopsy approach depends on developing clear evidence-based clinical guidelines and referral pathways, along with comprehensive education for all healthcare providers involved.