Coeliac disease screening is suboptimal in a tertiary gastroenterology setting

• Authors: Heba N. Iskandar, Emory University; Darrell M. Gray, Washington University; Hongha Vu, Washington University; Faiz Mirza, Washington University; Mary Katherine Rude, Washington University; Kara Regan, Washington University; Adil Abdalla, Washington University; Srinivas Gaddam, Washington University; Sami Almaskeen, Washington University; Michael Mello, Washington University; Evelyn Marquez, Washington University; Claire Meyer, Washington University; Ahmed Bolkhir, Washington University; Navya Kanuri, Washington University; Gregory Sayuk, Washington University; C Prakash Gyawali, Washington University
• Journal Title: Postgraduate Medical Journal
• Volume: Volume 93, Number 1102
• Publisher: BMJ Publishing Group | 2017-08-01, Pages 472-475
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1136/postgradmedj-2016-134005
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, General
• Keywords: Science & Technology; Life Sciences & Biomedicine; Medicine, General & Internal; General & Internal Medicine; GLUTEN-FREE DIET; PRIMARY-CARE; MANAGEMENT; DIAGNOSIS; MULTICENTER

Abstract

Background and aims Coeliac disease (CD) is widely prevalent in North America, but case-finding techniques currently used may not be adequate for patient identification. We aimed to determine the adequacy of CD screening in an academic gastroenterology (GI) practice. Methods Consecutive initial visits to a tertiary academic GI practice were surveyed over a 3-month period as a fellow-initiated quality improvement project. All electronic records were reviewed to look for indications for CD screening according to published guidelines. The timing of screening was noted (before or after referral), as well as the screening method (serology or biopsy). Data were analysed to compare CD screening practices across subspecialty clinics. Results 616 consecutive patients (49±0.6 years, range 16-87 years, 58.5% females, 94% Caucasian) fulfilled inclusion criteria. CD testing was indicated in 336 (54.5%), but performed in only 145 (43.2%). The need for CD screening was highest in luminal GI and inflammatory bowel disease clinics, followed by biliary and hepatology clinics (p<0.0001); CD screening rate was highest in the luminal GI clinic (p=0.002). Of 145 patients screened, 4 patients (2.4%) had serology consistent with CD, of which 2 were proven by duodenal biopsy. Using this proportion, an additional 5 patients might have been diagnosed in 191 untested patients with indications for CD screening. Conclusions More than 50% of patients in a tertiary GI clinic have indications for CD screening, but <50% of indicated cases are screened. Case-finding techniques therefore are suboptimal, constituting a gap in patient care and an important target for future quality improvement initiatives.