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Variability in Celiac Serology Testing by Provider Type: A Single-Center Experience.

Ankur Chugh1, Stanley F Lo2

  • 1From the Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI.

JPGN Reports
|May 18, 2023
PubMed
Summary
This summary is machine-generated.

Celiac disease (CD) serology ordering varied among providers. While antitissue transglutaminase antibody IgA was common, total IgA and other tests were inconsistently used, indicating potential guideline gaps.

Keywords:
adherenceguidelinesprimary care providersquality improvement

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Area of Science:

  • Pediatric Gastroenterology
  • Clinical Immunology
  • Diagnostic Testing

Background:

  • Celiac disease (CD) diagnosis relies on specific serological markers.
  • Standardized ordering practices for CD serologies are crucial for accurate diagnosis and efficient healthcare resource utilization.
  • Variations in provider ordering practices can lead to diagnostic delays or unnecessary testing.

Purpose of the Study:

  • To evaluate the ordering practices of celiac disease (CD) serologies by healthcare providers at a tertiary, academic children's hospital.
  • To compare these ordering practices against established clinical guidelines and best practices.
  • To identify reasons for variability and nonadherence in CD serology testing.

Main Methods:

  • A retrospective analysis of celiac serologies ordered in 2018 was conducted.
  • Data were categorized by provider type: pediatric gastrointestinal (GI) specialists, primary care providers (PCPs), and nonpediatric GI specialists.
  • Ordering patterns, test types, and adherence to guidelines were assessed.

Main Results:

  • Antitissue transglutaminase antibody IgA (tTG IgA) was the most frequently ordered test (n=2504).
  • Total IgA was ordered with tTG IgA in 81% of cases, but inconsistently by endocrinologists (49%).
  • Other tests like tTG IgG, deamidated gliadin peptide (DGP) IgA/IgG, antiendomysial antibody, and celiac genetics were infrequently ordered, with some inappropriate use noted.

Conclusions:

  • While tTG IgA ordering was generally appropriate, inconsistencies in ordering total IgA and underutilization of other diagnostic methods were observed.
  • Inappropriate ordering of DGP IgA/IgG and celiac genetic tests occurred.
  • The study highlights potential gaps in adherence to guidelines and suggests a need for improved education and standardization in celiac disease serology testing.