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Determining whether coeliac disease case-finding in primary care is better than random testing: a retrospective study
1Associate Specialist, Department of Gastroenterology, York Teaching Hospital NHS Foundation Trust, York, UK.
Insights
Case-finding for coeliac disease in primary care is no more effective than random population testing. Improved education on coeliac disease indications is necessary for both the public and physicians.
Area of Science:
- Gastroenterology
- Public Health
- Diagnostic Medicine
Background:
- Over 75% of coeliac disease patients in the UK remain undiagnosed, representing a significant public health challenge.
- Undiagnosed coeliac disease can lead to serious long-term health complications.
Purpose of the Study:
- To evaluate the effectiveness of case-finding strategies for coeliac disease in primary care settings.
- To compare case-finding with random testing for identifying coeliac disease.
Main Methods:
- A pragmatic study analyzed coeliac serology testing referrals and indications across 38 GP practices over 12 months.
- Follow-up data was collected for 12 months to track positive serology conversion to duodenal biopsy.
Main Results:
- Case-finding for coeliac disease in primary care demonstrated no significant advantage over random population testing.
- Only 71% of individuals with positive coeliac serology proceeded to a duodenal biopsy within the subsequent year.
Conclusions:
- Enhanced education for the public and primary care physicians regarding coeliac disease diagnostic indications is crucial.
- Primary care settings may not be the optimal environment for effective coeliac disease case-finding.
Background:
Over 75% of patients (approximately half a million) with coeliac disease in the UK have not been formally diagnosed.
Aim:
To determine if case-finding of coeliac disease is better than random testing in primary care.
Design & Setting:
A pragmatic study looked at all referrals across a 12-month period (December 2013-November 2014) for coeliac serology testing and the indications for testing across 38 GP practices in a well-defined geographical area in North Yorkshire. There was further follow-up for an additional 12 months to determine conversion of positive serology to duodenal biopsy.
Method:
All serology samples sent into York Hospital biochemistry department during the study period were analysed for the indication for testing. Positive results were cross-referenced for duodenal biopsies over the following 12 months on the York Hospital pathology database.
Results:
Case-finding of coeliac patients in primary care is no better than random testing of the population. Only 71% of patients with positive serology went on to have a duodenal biopsy in the following 12 months.
Conclusion:
More education of the population and of primary care physicians is needed around the indications for checking for coeliac disease. It may be that primary care is not the best place to case-find patients with coeliac disease.
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