Primary care physicians are under-testing for celiac disease in patients with iron deficiency anemia: Results of a national survey

Abstract

BackgroundIron deficiency anemia (IDA) is a common extra-intestinal manifestation of celiac disease (CD). Little is known about the frequency with which primary care physicians (PCPs) test for CD in patients with IDA. We aimed to describe how PCPs approach testing for CD in asymptomatic patients with IDA.MethodsWe electronically distributed a survey to PCPs who are members of the American College of Physicians. Respondents were asked whether they would test for CD (serologic testing, refer for esophagogastroduodenoscopy [EGD], or refer to GI) in hypothetical patients with new IDA, including: (1) a young Caucasian man, (2) a premenopausal Caucasian woman, (3) an elderly Caucasian man, and (4) a young African American man. These scenarios were chosen to assess for differences in testing for CD based on age, gender, and race. Multivariable logistic regression was used to identify independent predictors of testing.ResultsTesting for CD varied significantly according to patient characteristics, with young Caucasian men being the most frequently tested (61% of respondents reporting they would perform serologic testing in this subgroup (p<0.001)). Contrary to guideline recommendations, 80% of respondents reported they would definitely or probably start a patient with positive serologies for CD on a gluten free diet prior to confirmatory upper endoscopy.ConclusionsPCPs are under-testing for CD in patients with IDA, regardless of age, gender, race, or post-menopausal status. The majority of PCPs surveyed reported they do not strictly adhere to established guidelines regarding a confirmatory duodenal biopsy in a patient with positive serology for CD.

Prevalence of Celiac Disease in Omani Adults with Iron Deficiency Anemia of Unknown Cause

“…Primary healthcare workers in Western countries often fail to test for CD in patients presenting with extra-intestinal manifestations such as IDA, leading to diagnostic delays. 20 , 21 The same scenario is expected to be present in Middle Eastern and Arab countries. Therefore, this study aimed to estimate the prevalence of CD among Omani adults with IDA of unknown cause.…”

“…19 Primary health care workers often fail to test for CD in patients presenting with extra intestinal manifestations such as IDA leading to delay in the diagnosis in western countries. [20][21] It is expected to be the same in the Middle East and Arab countries. Therefore, this study aimed mainly to estimate the prevalence of celiac disease among Omani adults with IDA of unknown cause, attending the primary care facility at the Sultan Qaboos University Hospital (SQUH).…”

Iron Deficiency in Celiac Disease: Prevalence, Health Impact, and Clinical Management

“…Testing for CD varied significantly according to patient characteristics but, globally, PCPs are under-testing for CD in patients with IDA, regardless of age, gender, race, or post-menopausal status. In addition, most PCPs surveyed reported that they do not strictly adhere to established guidelines regarding a confirmatory duodenal biopsy in a patient with positive serology for CD [59].…”

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

“…This suggests a failure to recognise the pervasiveness of CD and a lack of clinical knowledge in how to properly approach diagnosing the condition, suggesting a level of medical inertia towards it. 22 Meanwhile, studies examining previous endoscopies in patients with CD demonstrated a failure to complete biopsies or take an adequate number of biopsy samples despite presence of symptoms suggestive of CD prior to diagnosis, resulting in delayed diagnoses. 23 24 …”