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Diagnosing Celiac Disease in Primary Care Settings

Celiac.com 04/10/2007 - Celiac disease is one of the most common chronic health disorders in western countries. Yet, due largely to poor awareness of celiac disease by primary care physicians, most celiac cases in North America go undiagnosed. A recent study published in the American Journal of Gastroenterology suggests that the North American diagnostic rate for celiac disease can be improved through the use of active case-finding strategies in the primary care setting.

The study set out to determine the most common celiac symptoms faced by clinicians, and to determine how effective an active case-finding strategy might be in raising the levels of diagnosis. The study drew from a large pool of individuals who attended one of three participating North American clinical practices. 737 women and 239 men with symptoms or conditions known to be associated with celiac disease were tested for immunoglobulin A anti-transglutaminase (tTG) antibodies, and those with elevated anti-tTG were then tested for IgA anti-endomysial antibodies (EMA). Those who tested positive for EMA were encouraged to undergo an intestinal biopsy and HLA typing.

The median age for those tested was 54.3 years. Of 976 subjects tested, 30 showed a positive anti-tTG test (3.07%, 95% CI 1.98–4.16). 22 patients (18 women, 4 men) were diagnosed with celiac. In these 22 cases, the most frequent reasons for celiac disease screening were bloating (12/22), thyroid disease (11/22), irritable bowel syndrome (7/22), unexplained chronic diarrhea (6/22), chronic fatigue (5/22), and constipation (4/22).

The prevalence of celiac disease in the serologically screened sample was 2.25% (95% CI 1.32–3.18).

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According to the study, active screening implementation substantially increased diagnostic rates from a baseline low of 0.27 cases per thousand visits (95% CI 0.13–0.41), to a rate of 11.6 per thousand visits (95% CI 6.8–16.4, P < 0.001).

The study concludes that the implementation of active strategies in primary care settings is likely to improve the diagnostic rate of celiac disease in North America.

Am J Gastroenterol 2007; 102:1–7

health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.

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