Journal of General Internal Medicine

, Volume 20, Issue 7, pp 644–646 | Cite as

Brief report: Physician awareness of celiac disease

A need for further education
  • Robert D. Zipser
  • Mary Farid
  • Donald Baisch
  • Bhairavi Patel
  • Devika Patel
Original Article

Abstract

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 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. Gastroenterology. 2001;120:636–51.PubMedCrossRefGoogle Scholar
  2. 2.
    Farrell RJ, Kelly CP. Current concepts: celiac sprue. N Engl J Med. 2002;346:180–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Green PHR, Jabri B. Coeliac disease. Lancet. 2003;362:383–91.PubMedCrossRefGoogle Scholar
  4. 4.
    Bode S, Gudmand-Hoyer E. Incidence and prevalence of adult celiac disease within a defined geographic area in Denmark. Scand J Gastroenterol. 1996;31:694–9.PubMedGoogle Scholar
  5. 5.
    Murray JA, Van Dyke C, Plevak MF, Dierkinsing RA, Zinsmeister AR, Melton LJ. Trends in the identification and clinical features of celiac disease in a North American community 1950–2001. Clin Gastroenterol Hepatol. 2003;1:19–27.PubMedCrossRefGoogle Scholar
  6. 6.
    Green PHR, Stavros SN, Panagi SG, et al. Characteristics of adult celiac disease in the USA: results of a national survey. Am J Gastrol. 2001;96:126–31.CrossRefGoogle Scholar
  7. 7.
    Zipser RD, Patel S, Yahya KZ, Baisch DW, Monarch E. Presentations of adult celiac disease in a nationwide patient support group. Dig Dis Sci. 2003;48:761–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Cranney A, Zarkadas M, Graham ID, Switzer C. The Canadian celiac health survey—the Ottawa chapter pilot. BMC Gastroenterol. 2003;3:8.PubMedCrossRefGoogle Scholar
  9. 9.
    Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003;163:286–92.PubMedCrossRefGoogle Scholar
  10. 10.
    Talley NJ, Valovinos M, Petterson TM, Carpenter HA, Melton LJ III Epidemiology of celiac sprue: a community based study. Am J Gastroenterol. 1994;89:843–6.PubMedGoogle Scholar
  11. 11.
    National Institutes of Health, Consensus Development Conference Statement, Celiac Disease. Available at: http://www.consensus.nih.gov. Accessed June 30, 2004.Google Scholar
  12. 12.
    Dickey W, McMillan SA. Changing diagnostic pathways in coeliac disease: most case now identified in primary care. Program of the 11th International Symposium on Coeliac Disease, Belfast, Northern Ireland, 2004:167.Google Scholar
  13. 13.
    Cronin CC, Feighery A, Ferriss JB, et al. High prevalence of celiac disease among patients with insulin-dependent (type 1) diabetes mellitus. Am J Gastroenterol. 1997;92:2210–2.PubMedGoogle Scholar
  14. 14.
    Iltanen S, Collin P, Korpela M, et al. Celiac disease and markers of celiac disease latency in patients with primary Sjogren’s syndrome. Am J Gastroenterol. 1990;94:1042–6.Google Scholar
  15. 15.
    Bonamico M, Mariani P, Danesi HM, et al. Prevalence and clinical picture of celiac disease in Italian Down’s syndrome patients: a multicenter study. J Pediatr Gastroenterol Nutr. 2001;33:139–43.PubMedCrossRefGoogle Scholar
  16. 16.
    Counsell CE, Taha A, Ruddell WSJ. Coeliac disease and autoimmune thyroid disease. Gut. 1994;35:844–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Collin P, Maki M, Keyrilainen O, Hallstrom O, Reunala T, Pasternack A. Selective IgA deficiency and celiac disease. Scand J Gastroenterol. 1992;27:367–71.PubMedGoogle Scholar
  18. 18.
    Corazza GR, Di Sario A, Cecchetti L, et al. Influence of pattern of clinical presentation and of gluten-free diet on bone mass and metabolism in adult coeliac disease. Bone. 1996;18:525–30.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2005

Authors and Affiliations

  • Robert D. Zipser
    • 1
  • Mary Farid
    • 2
  • Donald Baisch
    • 3
  • Bhairavi Patel
    • 3
  • Devika Patel
    • 3
  1. 1.Harbor-UCLA Medical CenterTorranceUSA
  2. 2.West Los Angeles Veterans Administration HospitalUSA
  3. 3.The Celiac Disease FoundationStudio CityUSA
  4. 4.San Dimas

Personalised recommendations