Original Article

Journal of General Internal Medicine

, Volume 20, Issue 7, pp 644-646

First online:

Brief report: Physician awareness of celiac disease

A need for further education
  • Robert D. ZipserAffiliated withHarbor-UCLA Medical Center Email author 
  • , Mary FaridAffiliated withWest Los Angeles Veterans Administration Hospital
  • , Donald BaischAffiliated withThe Celiac Disease Foundation
  • , Bhairavi PatelAffiliated withThe Celiac Disease Foundation
  • , Devika PatelAffiliated withThe Celiac Disease Foundation

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BACKGROUND: Celiac disease is a common disorder (up to 0.7%); however, it is uncommonly diagnosed in the United States.

OBJECTIVE: We sought to determine physician awareness of celiac disease.

DESIGN: Surveys completed by 2,440 (47%) of 5,191 patients in a support group were analyzed for frequency of diagnosis by physician specialties. Questionnaires were then sent to primary care physicians (PCPs) (n=132) in a southern California county to assess knowledge of celiac disease.

RESULTS: In patient surveys, only 11% were diagnosed by PCPs (internists and family physicians) versus 65% by gastroenterologists. Physician surveys (70% response) showed that only 35% of PCPs had ever diagnosed celiac disease. Almost all physicians (95%) knew of wheat intolerance, but few (32%) knew that onset of symptoms in adulthood is common. Physicians were well aware (90%) of diarrhea as a symptom, but fewer knew of common symptoms of irritable bowel syndrome (71%), chronic abdominal pain (67%), fatigue (54%), depression and irritability (24%) or of associations with diabetes (13%), anemia (45%) or osteoporosis (45%), or of diagnosis by endomysial antibody tests (44%).

CONCLUSIONS: Lack of physician awareness of adult onset of symptoms, associated disorders, and use of serology testing may contribute to the underdiagnosis of celiac disease.

Key words

celiac disease primary care physicians endomysial antibodies education