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Increasing Numbers at a Specialist Celiac Disease Clinic: Contribution of Serological Testing in Primary Care

The following abstract was submitted to celiac.com directly by William Dickey, Ph.D., a leading celiac disease researcher and gastroenterologist who practices at Altnagelvin Hospital, Londonderry, Northern Ireland.

Dig Liver Dis. 2005 Sep 29;
Dickey W, McMillan SA.
Department of Gastroenterology, Altnagelvin Hospital, Londonderry BT47 6SB, Northern Ireland, UK.

Celiac.com 10/11/2005 - BACKGROUND.: Serological testing, using IgA class endomysial and tissue transglutaminase antibodies has high sensitivity and specificity for celiac disease and allows case finding by clinicians other than gastroenterologists. We reviewed new celiac patients seen over a 9-year period to determine how the availability of serology, particularly to primary care physicians, has changed rates and sources of diagnosis.

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METHODS.: Files of patients attending a specialist celiac clinic who were diagnosed from 1996 through 2004 were reviewed. Patients with villous atrophy consistent with gluten sensitive enteropathy (Marsh III) on duodenal biopsy were selected. Data analyzed included clinical characteristics, endomysial and tissue transglutaminase antibodies status and source of request for serology.

RESULTS.: Over the study period 347 new celiac patients, comprising adults and children aged 10 years and over, were identified, of whom 163 (47%) were identified by serological testing in primary care, 152 (44%) at the hospital gastroenterology department and 32 (9%) by other physicians in secondary care. Over three consecutive 3-year periods, the percentage of patients identified in primary care rose from 28% through 47% to 60%, with a rise in total numbers diagnosed from 93 through 118 to 136. There was no change in patient clinical characteristics over the study period. Though tissue transglutaminase antibodies were less sensitive than endomysial antibodies, combined testing obtained a sensitivity of over 90%. Patients identified in primary care were significantly younger and more likely to present with diarrhea as a primary symptom.

CONCLUSION.: Currently over half of our celiac patients are identified by serological testing in primary care, which has resulted in an overall rise in diagnosis rates. Primary care practitioners have an important role in the diagnosis of celiac disease, particularly of patients who present with non-gastrointestinal symptoms. The contribution of specialists other than gastroenterologists in secondary care is disappointing and may improve with directed education.

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The only symptom I know of that is celiac for certain is dh, which must be diagnosed by a dermatologist.

I have both eoe and celiac and now that I have been gluten free for 18 months, my anemia is gone. It is good to get off the iron supliments because mine may have been the cause of my ulcers. It feels good to recover and heal! I may work my way down to fewer supliments and lots of feel great da...

Your daughter does not have a strong positive. I suspect that the GI might do as RMJ suggested which would be to load her up on gluten for six months and retest. On the other hand, with a diagnosed sibling and a very mild positive, your GI might recommend the endoscopy or run the test again to ...

I was diagnosed with celiac last year on an endoscopy looking for the cause of my anemia. At the time, my GI doc tested m for EoE and it was negative. Fast forward 11 months, I developed sudden heart burn, dysphagia out of the blue. My doc thinks it's EoE. Biopsy was last week and I am still wait...

No, the control test is to verify that she will react to that particular type of test. If she didn't, then certain of the bloods would not be applicable to her. They would be false negatives. As far as tests being weak positives, that's like being a little pregnant. A positive is a positive....