Interprovider variation of celiac disease testing in childhood chronic abdominal pain
Bruno Pedro Chumpitazi1, Krupa Mysore, Cynthia Man-Wai Tsai
1Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. chumpita@bcm.edu.
Insights
Many children with chronic abdominal pain are not tested for celiac disease (celiac disease). While testing varied by race, it did not differ between providers. Celiac disease was diagnosed in 4.9% of tested children.
Area of Science:
- Pediatric Gastroenterology
- Celiac Disease Diagnosis
- Gastrointestinal Disorders
Background:
- Chronic abdominal pain is a common pediatric complaint.
- Celiac disease is an autoimmune disorder that can cause chronic abdominal pain.
- Testing for celiac disease in children with chronic abdominal pain can vary.
Purpose of the Study:
- To determine provider variation in celiac disease testing for children with chronic abdominal pain.
- To identify characteristics of children more likely to be tested for celiac disease.
- To ascertain the prevalence of celiac disease in evaluated children.
Main Methods:
- Retrospective review of children with chronic abdominal pain evaluated at a tertiary care center over two years.
- Inclusion criteria: at least two visits and no identified organic cause for pain.
- Data collected on provider testing practices, patient demographics, and diagnostic outcomes.
Main Results:
- Celiac serologic testing was performed in 39.4% of 160 evaluated children.
- No significant variation in testing frequency was observed between 16 pediatric gastroenterologists and one nurse practitioner.
- Caucasian children were more likely to be tested; gastrointestinal symptoms did not predict testing.
- Celiac disease was diagnosed in 4.9% of the 82 children who underwent testing.
Conclusions:
- A significant number of children with chronic abdominal pain were not evaluated for celiac disease.
- Race/ethnicity influenced celiac testing, but gastrointestinal symptoms did not.
- The prevalence of celiac disease in tested children was higher than in the general population.
Background:
To determine within one tertiary care center: 1) the variation between providers in testing for celiac disease in children with chronic abdominal pain; 2) the characteristics of those children who were more likely to be tested, and 3) the prevalence of celiac disease in those evaluated.
Methods:
Retrospective review of children with a primary complaint of chronic abdominal pain referred to a tertiary care children's hospital for pediatric gastroenterology evaluation over a 2-year period was conducted. Children with at least two visits and without an identified organic etiology for the pain were included.
Results:
160 children were evaluated by 16 pediatric gastroenterologists and one nurse practitioner. Celiac serologic testing was completed in 63 (39.4%) children. There was no significant variance in the frequency of celiac serologic testing between providers. Child age, gender, body mass index, and baseline gastrointestinal symptoms did not predict whether celiac serologic testing occurred, though Caucasians (P < 0.01) were more likely to be tested. Eighty-two (51.3%) children underwent either serologic testing and/or esophagogastroduodenoscopy. Four (4.9%, 95% CI: 1.6-11.3%) of the 82 tested were diagnosed with celiac disease.
Conclusions:
Though interprovider variation for celiac disease testing in children with chronic abdominal pain did not occur, a large number of these children were not evaluated for celiac disease. Children's race/ethnicity but not their associated gastrointestinal symptoms predicted whether celiac testing was undertaken. In those tested, celiac disease was identified in a higher percentage than that expected in the general population.
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