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Coeliac disease in primary care: case finding study

H Hin1, G Bird, P Fisher

  • 1HaroldHin@pgec-horton.demon.co.uk

BMJ (Clinical Research Ed.)
|January 15, 1999
PubMed
Summary

Coeliac disease is frequently underdiagnosed in primary care, often presenting with non-gastrointestinal symptoms like anemia. Early serological screening in general practice can identify many undiagnosed cases.

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Area of Science:

  • Gastroenterology
  • Immunology
  • Primary Care Medicine

Background:

  • Coeliac disease is often underdiagnosed and misdiagnosed in primary care settings.
  • This can lead to prolonged and avoidable patient suffering and morbidity.

Purpose of the Study:

  • To provide evidence for the underdiagnosis of coeliac disease.
  • To describe the primary presenting symptoms of coeliac disease in general practice.

Main Methods:

  • Case finding was conducted in primary care using the endomysial antibody test for coeliac disease.
  • The study involved screening 1000 patients across nine surgeries in central England.
  • Positive antibody tests were confirmed with small intestine biopsy.

Main Results:

  • 30 out of 1000 patients screened had confirmed coeliac disease via biopsy.
  • The most common presenting symptom was anemia (15/30 patients).
  • A majority of patients (25/30) presented with non-gastrointestinal symptoms; the endomysial antibody test showed 100% specificity.

Conclusions:

  • Underdiagnosis and misdiagnosis of coeliac disease are prevalent in general practice.
  • Serological screening in primary care is effective in identifying a significant number of patients.
  • Coeliac disease should be considered in patients with anemia or fatigue, particularly with a family history.

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