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Impact of delay in diagnosis in patients with celiac disease: A study of 570 patients at a tertiary care center

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Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

The varied presentation of celiac disease (CD) makes it challenging to diagnose it and predisposes to a significant diagnostic delay. We undertook a study to evaluate the effect of delayed diagnosis of CD on its systemic and laboratory manifestations.

Methods

In this retrospective analysis of prospectively collected data (January 2015 to December 2018), patients with CD ≥ 12 years were evaluated for clinical presentation and laboratory parameters. Based on duration of symptoms at the time of diagnosis, the patients were divided into 2 groups: group 1 (early diagnosis): ≤ 3 years, group 2 (delayed diagnosis): > 3 years. The two groups were compared for demographic, clinical, laboratory, and histological manifestations.

Results

Of the 570 patients, 289 constituted group 1 (early diagnosis) and 281 group 2 (delayed diagnosis). There was no age or sex difference between the two groups and both had comparable body mass index (BMI). Patients in the delayed group had lower rates of diarrhea as initial presentation with lower physician and gastroenterologist consultation and significantly higher rates of anemia, pubertal delay, and menstrual irregularities as well as higher rates of low hemoglobin, low ferritin, low transferrin saturation, and low vitamin D levels. The delayed group also had significantly higher anti-tissue transglutaminase antibody (anti-tTg Ab) titers and higher grades of villous atrophy at presentation.

Conclusion

Patients with CD with more than 3 years of symptoms, more often have atypical presentation, anemia, pubertal delay, and more advanced histological changes. They also have fewer physician and gastroenterologist consultations. This underlines the need for proper awareness to ensure early diagnosis and treatment.

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Author notes

  1. Jahnvi Dhar and Jayanta Samanta have contributed equally and should be considered as co-first authors.

Authors and Affiliations

  1. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160 012, India

    Jahnvi Dhar, Jayanta Samanta, Megha Sharma, Sanjay Kumar, Saroj Kant Sinha & Rakesh Kochhar

Authors
  1. Jahnvi Dhar
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  2. Jayanta Samanta
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  3. Megha Sharma
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  4. Sanjay Kumar
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  5. Saroj Kant Sinha
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  6. Rakesh Kochhar
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Contributions

JD: conception and acquisition of data, drafting the initial manuscript, final approval. JS: conception of the study, analysis and interpretation of the data, drafting the manuscript, final approval. MS and SK: acquisition of the data, critical review of the manuscript, final approval. SKS and RK: conception of the study, critical review of the manuscript, final approval. All the authors have approved the final version of the article, including the authorship list.

Corresponding author

Correspondence to Rakesh Kochhar.

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Conflict of interest

JD, JS, MS, SK, SKS, and RK declare no competing interests.

Ethics statement

The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

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Dhar, J., Samanta, J., Sharma, M. et al. Impact of delay in diagnosis in patients with celiac disease: A study of 570 patients at a tertiary care center. Indian J Gastroenterol 41, 30–36 (2022). https://doi.org/10.1007/s12664-021-01214-3

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  • DOI: https://doi.org/10.1007/s12664-021-01214-3

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