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The environmental impact of pediatric celiac disease diagnosis and follow-up
Mario Brusco1, Sara Trivellini1, Rita Cozzali1
1Department of Surgical and Biomedical Sciences, Paediatric Clinic, "S. Maria della Misericordia" University Hospital University of Perugia Perugia Italy.
Insights
The no-biopsy approach for diagnosing celiac disease (CeD) significantly reduces carbon dioxide (CO2) emissions compared to traditional biopsy methods. Evaluating telemedicine and primary care referrals can further enhance environmental sustainability in CeD management.
Area of Science:
- Environmental Health
- Pediatric Gastroenterology
- Public Health
Background:
- Celiac disease (CeD) diagnosis and management involve practices with environmental implications.
- Assessing the carbon footprint of healthcare is crucial for sustainable medical practices.
Purpose of the Study:
- To evaluate the carbon dioxide (CO2) footprint associated with celiac disease diagnostic guidelines and follow-up care in pediatric patients.
- To compare the environmental impact of biopsy-confirmed CeD diagnosis versus non-biopsy diagnostic approaches.
Main Methods:
- Retrospective study of 236 pediatric patients diagnosed and followed for CeD in the Umbria region (2020-2023).
- Patients categorized into two groups: duodenal biopsy (Group 1) and no-biopsy diagnosis (Group 2).
- Calculated CO2 emissions based on transport, anesthesia, and upper GI endoscopy procedures.
Main Results:
- Median annual CO2 cost per patient was significantly lower in the no-biopsy group (57.2 kg) compared to the biopsy group (397.9 kg).
- Follow-up care resulted in similar annual CO2 emissions from car travel for both groups (approx. 39.3 kg).
Conclusions:
- The no-biopsy diagnostic approach for CeD substantially decreases CO2 emissions.
- Further evaluation is needed for telemedicine, primary care integration, and reduced outpatient consultations to improve environmental sustainability in CeD follow-up.
Objectives:
To evaluate carbon dioxide (CO2) footprint of celiac disease (CeD) diagnostic guidelines and follow-up practices for children/adolescents.
Methods:
Two-hundred and thirty-six patients diagnosed and followed up for CeD in Umbria region during 2020-2023 were included in this retrospective study. Patients were divided in two groups: Group 1 included patients diagnosed by duodenal biopsies (total: 43), while Group 2 included no-biopsy patients (total: 193). Transport emissions of CO2 per kilometer traveled by a diesel car was estimated as 171 g/km. CO2 cost was estimated as 22 kg for each anesthesia and as 5.4 kg for each upper GI endoscopy.
Results:
The median CO2 cost/patient/year in Group 1 was 397.9 kg, while the median CO2 cost/patient/year in Group 2 was 57.2 kg (p < 0.001). As regards the follow-up of these children, we estimated a median CO2 amount of 39.3 kg produced per year by car emission and there was no difference between the two groups (Group 1 40.5 kg vs. Group 2 38.1 kg; p:ns).
Conclusions:
The no-biopsy approach for the CeD diagnosis strongly decreases the CO2 emissions. Whether implementing telemedicine, handing over to primary care or reducing outpatient consultations for follow-up will be feasible and environmentally more sustainable should be evaluated.
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