Barriers impeding serologic screening for celiac disease in clinically high-prevalence populations

Area of Science:

• Gastroenterology
• Immunology
• Public Health

Background:

• Celiac disease affects approximately 1% of the population in the US and Europe.
• A significant majority (~85%) of celiac disease cases remain undiagnosed, with diagnosis delays averaging 5.8-11 years.
• Delayed diagnosis is often due to a case-based detection approach and healthcare professional knowledge gaps, rather than general screening.

Purpose of the Study:

• To investigate patient-centered barriers that hinder serologic screening for celiac disease.
• To assess these barriers in individuals at increased clinical risk for celiac disease.

Main Methods:

• 119 high-risk adults completed a survey on demographics, symptoms, family history, comorbidities, and screening barriers.
• Serologic screening included IgA tissue transglutaminase antibody (IgA tTG) and confirmatory IgA anti-endomysial antibody (IgA EMA) testing.
• Analysis focused on identifying significant barriers to serologic testing.

Main Results:

• Key barriers identified were lack of awareness of personal risk for celiac disease and not knowing where to get tested.
• For lower-income and younger participants, lack of a doctor to order the test was a significant barrier, correlating with lack of health insurance.
• No significant differences in symptoms or comorbidities were observed between participants who tested negative and those who tested positive for IgA tTG.

Conclusions:

• Patient-centered barriers significantly impede serologic screening, contributing to delayed celiac disease detection and diagnosis.
• Enhanced public and professional education regarding celiac disease symptoms, risk factors, and available testing is crucial.
• Addressing these barriers can improve early detection and diagnosis rates for celiac disease.