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Introduction Coeliac disease has an estimated UK prevalence of 1% and is an important, common cause of many gastro-intestinal and non-gastro-intestinal symptoms. Coeliac serological blood tests are commonly performed in both primary and secondary care. Positive coeliac serology occurs in patients with: (i) Coeliac disease, (ii) Latent Coeliac disease, (iii) Dermatitis herpetiformis. The UK national institute for health and clinical excellence (NICE), 1 British society of gastroenterology guidelines (BSG) and American Gastroenterology Association (AGA) 2 guidelines recommend that all patients with positive coeliac serology undergo duodenal biopsy since diagnosis of coeliac disease requires both positive serology and typical histological findings. Methods We reviewed the results of all coeliac serology tests performed at our hospital laboratory in the previous 12 months. The case notes for all patients with positive results were reviewed. Results 6394 endomysial antibody results were performed on adult patients between 1 October 2010 and 30 September 2011. 100 (1.6%) were positive. Of these 67 (67.0%) underwent biopsy. 50 (74.6%) had histological evidence of coeliac disease; 5 (7.5%) were inconclusive and 11 (16.4%) had no evidence of coeliac disease. Of those who did not undergo biopsy 11 (33.0%) were known to have CD or refused D2 biopsy. In 22 (21.6%) patients gastroenterological follow-up had not been arranged, of these 16 (72.7%) tests had been arranged in primary care. Conclusion In this study 1.6% of those tested had serology suggestive of coeliac disease, this is marginally larger than expected by chance and suggests that testing was not appropriately targeted. Surprisingly 21.6% of positive tests did not have appropriate followup arranged. We suspect these findings are not confined to our institution. Our findings suggest that engagement and education of non-gastroenterology colleagues, particularly those in primary care is important in order that patients receive appropriate treatment and conform to AGA, BSG and NICE guidelines. We plan in future that all positive coeliac serology test reports be issued with the advice that referral to a gastroenterologist is recommended.Competing interests None declared.

quadrantic biopsies. DNA content abnormalities (aneuploidy/tetraploidy); loss of heterozygosity (LOH) at 9p and 17p loci; RUNX3, HPP1 and p16 methylation; immunohistochemistry (IHC) for p53 and Cyclin A were tested on targeted biopsies. Each biomarker was correlated with the dysplasia and AFI status. Results 111 patients with 210 biopsy areas were included in the analysis (AFI+, n¼120; AFI-, n¼90). Univariate per-biopsy analysis showed that all biomarkers correlated with dysplasia (p<0.05), with exception of 9p LOH. Multivariate analysis showed that aneuploidy, p53 IHC and Cyclin A (3 biomarker panel) were independently associated with dysplasia with an AUC¼0.93 (95% CI 0.88 to 0.98) for any dysplasia and AUC¼0.95 (95% CI 0.89 to 1) for HGD/early cancer (EC). AFI positivity significantly correlated with aneuploidy, p16 methylation, cyclin A and p53 staining (p<0.05). After excluding dysplastic areas, aneuploidy (p¼0.03) and p53 (p¼0.04) staining retained statistical correlation with AFI positivity. Analysis of the 3 biomarker panel in patients with dysplasia showed significant biomarker enrichment in AFI+ compared to AFI-areas (p¼0.001). Finally, 3 biomarker panel was used to predict prevalent dysplasia. Using a cut-off of $2 biomarkers, the panel when applied to AFI+ areas alone, showed sensitivity and specificity of 88% and 90% respectively for diagnosis of HGD/EC, and 64% and 96% respectively for diagnosis of any dysplasia, compared to overall histology. Conclusion AFI increases detection rate for molecular biomarkers. A panel of 3 molecular biomarkers on a small number of AFI targeted biopsies can efficiently predict the dysplasia status and potentially inform therapeutic management of patients with BE.