The economics of coeliac disease: a population‐based study

Long, Kirsten Hall; Rubio–Tapia, Alberto; Wagie, Amy E.; Melton, L. Joseph; Lahr, Brian D.; Dyke, Carol T. Van; Murray, Joseph A.

doi:10.1111/j.1365-2036.2010.04327.x

Cited by 85 publications

(74 citation statements)

References 36 publications

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“…Recent research has shown that early diagnosis and treatment of CD are associated with reduced medical costs for celiac patients up to $1764 in the year following diagnosis [13]. As increasing efforts are made to decrease medical costs, more attention will be focused on the cost effectiveness of routine endoscopic biopsies.…”

Section: Discussionmentioning

confidence: 99%

Routine Duodenal Biopsies in the Absence of Endoscopic Markers of Celiac Disease Are Not Useful: An Observational Study

et al. 2013

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Background. European studies have shown the utility of limiting endoscopic biopsies to diagnose celiac disease (CD) to patients that have high-risk symptoms or present with positive serology. However, many centers in the U.S. have open access endoscopy. Patients are referred without prior serologic testing, and endoscopists often decide whether or not to biopsy at the time of procedure. Aims. Evaluate the yield of duodenal biopsies for the diagnosis of CD in patients undergoing upper endoscopy without prior serologic testing. Methods. This retrospective study evaluated the frequency of CD diagnosis based duodenal biopsies. Researchers were interested in the yield of endoscopic stigmata findings in patients with high-risk symptoms versus low risk. Results. Eight hundred and ten patients met entry criteria at the Cleveland Clinic Florida between 2004 and 2008; 320 presented with highrisk symptoms; and 490 low risk. Sixty-one (7.5%) displayed endoscopic stigmata, and 10/61 (16.3%) were diagnosed with CD. Only patients who exhibited endoscopic stigmata were later diagnosed based on histologic findings. The presence of endoscopic stigmata greatly increased the probability of diagnosing CD, with a positive likelihood ratio of 15.6. Conclusions. When performing upper endoscopy without known serological markers for CD, clinicians should limit duodenal biopsies to patients with high-risk symptoms or endoscopic stigmata.

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Section: Discussionmentioning

confidence: 99%

Routine Duodenal Biopsies in the Absence of Endoscopic Markers of Celiac Disease Are Not Useful: An Observational Study

et al. 2013

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“…Studies of patient groups prescribed exclusion diets -e.g. people with coeliac disease -document the substantial costs of these to both patient quality of life and public health budgets (44,45) . A risk for the selfdiagnosed is that the misinterpretation of symptoms may lead to unnecessarily restrictive diets and potentially serious dietary imbalances (46,47) .…”

Section: Discussionmentioning

confidence: 99%

Motivations for avoiding wheat consumption in Australia: results from a population survey

Golley

Corsini

Topping

et al. 2014

Public Health Nutr.

123

105

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Objective: To assess the prevalence of and explanations for wheat avoidance, including reported symptoms, diagnoses and information sources influencing the decision to avoid wheat, and to investigate potential psychological predictors of this behaviour. Design: Cross-sectional population survey. Setting: The study was conducted in Australia, using a nationwide postal omnibus survey. Subjects: Adults aged 18 years and over (n 1184; 52·9 % female) selected at random from the Australian Electoral Roll. Results: With cases of stated and suspected coeliac disease (1·2 %) excluded, 7·3 % of the sample reported adverse physiological effects, predominantly gastrointestinal, that they associated with wheat consumption. Few among this group (5·7 %) claimed a formally diagnosed intolerance or allergy requiring avoidance of wheatbased foods. Symptomatic wheat avoidance was highly correlated with dairy avoidance and predicted by gender (female), lesser receptiveness to conventional medicine and greater receptiveness to complementary medicine, but not by neuroticism, reasoning style or tendency to worry about illness. Conclusions:The data indicate that many adult Australians are consciously avoiding consumption of wheat foods, predominantly without any formal diagnosis. Reported symptoms suggest a physiological but not allergenic basis to this behaviour. Questions to be answered concern whether symptoms are attributed correctly to wheat, the agents (wheat components, dietary factors or additives) and physiological mechanism(s) involved, the nutritional adequacy of avoiders' diets, and the clinical and psychosocial processes that lead a substantial number of adults to avoid consuming wheat (or any other dietary factor) apparently independently of a medical diagnosis.

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“…9 Given the reduction in mortality risk that occurs in the years after diagnosis and institution of the gluten-free diet 10 and the reduced health care expenditures after diagnosis of CD, 2 screening for CD may be cost effective, and was found to be so in to three quantitative analyses. [11][12][13] Despite calls for general population screening, problems with this approach have led to targeted case finding as the preferred method of increasing diagnosis rates. Apart from unresolved questions regarding the logistics of screening (such as deciding on the appropriate age and interval of screening) limitations of the currently available serological tests pose a significant problem.…”

Section: Identifying the Appropriate Patient To Test For Celiac Diseasementioning

confidence: 99%

Diagnosis of Celiac Disease

Tavakkoli

Lebwohl

2013

Clinical Gastroenterology

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The economics of coeliac disease: a population‐based study

Abstract: SUMMARY BackgroundDespite increasing prevalence, the economic implications of coeliac disease are just emerging.

Cited by 85 publications

References 36 publications

Routine Duodenal Biopsies in the Absence of Endoscopic Markers of Celiac Disease Are Not Useful: An Observational Study

Routine Duodenal Biopsies in the Absence of Endoscopic Markers of Celiac Disease Are Not Useful: An Observational Study

Motivations for avoiding wheat consumption in Australia: results from a population survey

Diagnosis of Celiac Disease

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