IntroductionPatients with the postural tachycardia syndrome (PoTS) have anecdotally reported symptom improvement on a gluten-free diet (GFD) but there has been no association study between PoTS and coeliac disease. Therefore, we aimed to evaluate the prevalence of coeliac disease and self-reported gluten sensitivity in a cohort of patients with PoTS and compare this with local population data.Methods100 PoTS patients were recruited from the syncope clinic to complete a validated questionnaire which screened for gluten sensitivity and related symptoms. Case notes were reviewed for relevant GI diagnoses. For comparison, the local coeliac prevalence was determined from a total of 1200 controls (Control Group 1) and a further 400 controls (Control Group 2; frequency matched for age and sex) filled out the same questionnaire.ResultsFour out of a hundred (4%) patients with PoTS had serology and biopsy-proven coeliac disease. This was significantly higher than the prevalence of coeliac disease in Control Group 1 (12/1200, 1%; OR 4.1, 95% CI 1.3 to 13.0; p = 0.02). In comparison with Control Group 2, patients with PoTS had a higher prevalence of self-reported gluten sensitivity (42% versus 19%; p < 0.001), coeliac disease (4% versus 1%; p = 0.04) and IBS (36% versus 9%; p < 0.0001).ConclusionThere is a high prevalence of coeliac disease and self-reported gluten sensitivity in patients with PoTS. We advocate screening for the gluten-related disorders in patients with PoTS. Further studies are required to ascertain the nature of this relationship.Disclosure of InterestNone Declared
IntroductionClinicians’ knowledge and practice may directly affect patients’ diagnostic pathway. An Endomysial antibody (EMA) has a>90% positive predictive value for coeliac disease. Furthermore NICE have recommended that patients with suspected coeliac disease should have an endoscopy and biopsy within 6 weeks. This should serve to reduce the temptation by the patient to start a Gluten free diet (GFD). We aimed to determine GI Consultant practice by assessing their ‘grading’ for patients referred from primary care with a positive EMA. In addition, we sought to determine Gastroenterologists’ views about coeliac disease.MethodData regarding time to diagnostic endoscopy was collected from adult patients who had a positive EMA test in primary care from 2 centres (n=151). As a comparator cohort, we collected data regarding the time from symptom presentation in primary care to index endoscopy in adults referred with suspected IBD (n=92). In addition, an unselected cohort of Gastroenterology consultants and specialist registrars (n=50) completed a questionnaire regarding coeliac disease.ResultsThe median time from positive EMA identified in primary care to referral for diagnostic endoscopy was 23 (12-35) days; the time from referral to endoscopy was 55 (26-90) days. Overall, coeliac patients waited significantly longer from referral to endoscopy than patients who were diagnosed with IBD (34.5 [18-70] days; p=0.006). Overall time from EMA positive blood test to endoscopy was 78 (58-120) days.32% (16) of Gastroenterologists failed to identify that coeliac disease was more prevalent in the adult population than IBD. 16% (8) of respondents felt that a diagnosis of coeliac disease does not significantly impact patient quality of life. 36% (18) felt that doctors were not required for the adequate management of coeliac disease.ConclusionThere are delays in diagnosis for patients with coeliac disease. This may impact treatment intensification and thus patient related outcomes. Our data suggest that provider-related beliefs may contribute to clinical inertia in this condition. We advocate enhancing both undergraduate and postgraduate training about coeliac disease to help reduce this effect.Disclosure of InterestNone Declared
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.