title: Is under diagnosis of celiac disease compounded by mismanagement in the primary care setting?. A survey in the Italian Province of Brescia.
abstract: OBJECTIVE
  Celiac disease is under diagnosed in the primary care setting, mainly because of lack of awareness on the heterogenic manifestation of the disease. Furthermore, patients diagnosed at open access endoscopy may be mismanaged with incomplete dietary information. The aim of this paper was to evaluate prevalence and incidence in 1996 and 1997 for celiac disease in the Italian Province of Brescia and to obtain information on the extent of underdiagnosis and mismanagement.
  
  
  METHODS
  The authors assessed the under diagnosis of celiac disease by relating the number of patients on gluten-free diet at 31 December 1997 (prevalent cases) to the expected number of patients in a population of 1,055,499 assuming 1/200 disease prevalence. Post-diagnosis management was assessed by questionnaire for all incident cases in the hospital practice and in the primary care setting.
  
  
  RESULTS
  Five hundred and ninety-four prevalent cases were identified compared with an estimated disease prevalence of 5,000 cases, a figure corresponding to 8/9 under diagnosis. One hundred and thirty-five incident cases during 1996-1997 have been identified. Overall 80% of incident cases were symptomatic, but 40% only with the classical symptoms of malabsorption. Forty-three of the 135 incident cases did not receive appropriate dietary education following diagnosis, a figure corresponding to 1:3 mismanagement, and all of them were diagnosed in the primary care setting at open access endoscopy.
  
  
  CONCLUSIONS
  Our study indicates that under diagnosis of celiac disease in the primary care setting is compounded by disease mismanagement, a finding suggesting the need for increasing awareness not only on the heterogenicity of clinical manifestation but also on the appropriate dietary management of celiac disease.
authors.affiliation: Internal Medicine, Spedali Civili and Medical School, 25125 Brescia, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Lanzarotto
authors.forename: F
authors.initials: F
authors.lastname: Crimí
authors.forename: M
authors.initials: M
authors.lastname: Amato
authors.forename: V
authors.initials: V
authors.lastname: Villanacci
authors.forename: N M
authors.initials: NM
authors.lastname: Pillan
authors.forename: A
authors.initials: A
authors.lastname: Lanzini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007558:Italy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D012189:Retrospective Studies