Do gastroenterologists have medical inertia towards coeliac disease? A UK multicentre secondary care study

Abstract

ObjectiveThis study aimed to assess if there is secondary care medical inertia towards coeliac disease (CD).DesignGroup (1): Time from primary care presentation to diagnostic endoscopy was quantified in 151 adult patients with a positive endomysial antibody test and compared with 92 adult patients with histologically proven inflammatory bowel disease (IBD). Group (2): Across four hospitals, duodenal biopsy reports for suspected CD were reviewed (n=1423). Group (3): Clinical complexity was compared between known CD (n=102) and IBD (n=99) patients at their respective follow-up clinic appointments. Group (4): 50 gastroenterologists were questioned about their perspective on CD and IBD.ResultsGroup (1): Suspected coeliac patients waited significantly longer for diagnostic endoscopy following referral (48.5 (28–89) days) than suspected patients with IBD (34.5 (18–70) days; p=0.003). Group (2): 1423 patients underwent diagnostic endoscopy for possible CD, with only 40.0% meeting guidelines to take four biopsies. Increased diagnosis of CD occurred if guidelines were followed (10.1% vs 4.6% p<0.0001). 12.4% of newly diagnosed CD patients had at least one non-diagnostic gastroscopy in the 5 years prior to diagnosis. Group (4): 32.0% of gastroenterologists failed to identify that CD has greater prevalence in adults than IBD. Moreover, 36.0% of gastroenterologists felt that doctors were not required for the management of CD.ConclusionProlonged waiting times for endoscopy and inadequacies in biopsy technique were demonstrated suggesting medical inertia towards CD. However, this has to be balanced against rationalising care accordingly. A Coeliac UK National Patient Charter may standardise care across the UK.

Work Loss in Patients With Celiac Disease: A Population-based Longitudinal Study

“…20 Nevertheless, there seems to be a tendency of inertia towards CD within the medical community. 21 Unlike CD, work loss in inflammatory bowel disease has been extensively studied. 19,22,23 In comparison to the most recent such study, 19 also conducted in Sweden, patients with CD had similar, if not more, work loss than patients with ulcerative colitis (w12 vs w14 days), but less work loss than patients with Crohn's disease (w34 vs w14 days).…”

Clinical Manifestation and Diagnostic Process of Celiac Disease in Poland—Comparison of Pediatric and Adult Patients in Retrospective Study

“…We suggest that diagnostic delays in adults can be associated with a non-specific varied clinical picture, but also with this diagnostic approach based on histopathological assessment. A recent study performed in the United Kingdom revealed that the majority of endoscopists did not follow guidelines for diagnostic endoscopy for CD, which led to a reduction in diagnosis rates by over 50% [ 17 ]. In addition, the longer diagnostic delay observed in adults might result from the fact that, in Poland, CD has been regarded as a pediatric disease until quite recently [ 9 ].…”

Upper Gastrointestinal Tract Associated Lesions in Patients with Newly Diagnosed Celiac Disease

“…A routine duodenal biopsy in patients performing gastroscopy for refractory GERD or anemia is not a cost-effective approach, so the indication for biopsy should always have the right reasons, including to justify the cost [65,66]. Not least, there is low adherence to the current recommendation of multiple biopsy sampling, with some studies showing that some patients are diagnosed based on a single biopsy specimen [67][68][69].…”