The hunt for coeliac disease in primary care.
BACKGROUND
Serological screening suggests that most coeliac disease goes undetected.


OBJECTIVE
To determine how often coeliac disease is found in patients referred for gastroscopy by general practitioners.


METHODS
Testing of 9971 consecutive patients referred to a single health centre for their first open-access gastroscopy over a 10-year period, without previously-diagnosed coeliac disease or dermatitis herpetiformis.


METHODS
Endoscopy and routine duodenal biopsy were in use throughout the study period. The occurrence of coeliac disease was evaluated in patients with dyspepsia, in those with regurgitation, and in those with symptoms suggestive of coeliac disease.


RESULTS
Altogether, 147 (1.47%) patients had coeliac disease: 18/2974 (0.61%) with regurgitation, 41/5347 (0.77%) with dyspepsia, and 88/1650 (5.33%) with suspected coeliac disease. Increasing age reduced the risk very slightly (OR 0.98; 95%CI 0.97-0.99). Risk was significantly increased when there was a suspicion of coeliac disease (OR 9.085; 95%CI 5.371-15.369), while no difference was found between patients with dyspepsia and those with reflux disease (OR 1.33; 95%CI 0.75-2.34). The risk in women was not increased (OR 0.97; 95%CI 0.69-1.38).


CONCLUSIONS
In this primary-care setting, <1% of patients with upper abdominal symptoms suffered from coeliac disease; population-based serological screening is expected to yield a corresponding prevalence. When physicians had suspected coeliac disease, the condition was nine times more common.
Collin
P
P
Department of Internal Medicine, Tampere University Hospital, Finland. pekka.collin@uta.fi
Rasmussen
M
M
Kyrönpalo
S
S
Laippala
P
P
Kaukinen
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis*; D002648:Child; D015331:Cohort Studies; D004415:Dyspepsia / Q000209:etiology; D005194:Family Practice / Q000592:standards; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012044:Regression Analysis