title: Detection of Celiac disease in primary care: a multicenter case-finding study in North America.
abstract: BACKGROUND
  Celiac disease (CD) is one of the most common lifelong disorders in western countries. However, most cases remain currently undiagnosed in North America, mostly due to poor awareness of CD by primary care physicians.
  
  
  OBJECTIVE
  The aims of this study were (a) to determine whether an active case-finding strategy in primary care could increase the frequency of CD diagnosis and (b) to determine the most common clinical presentations of the condition.
  
  
  METHODS
  This was a multicenter, prospective study involving adult subjects during the years 2002-2004, attending one of the participating practices. All individuals with symptoms or conditions known to be associated with CD were tested for immunoglobulin A anti-transglutaminase (tTG) antibodies, and those with elevated anti-tTG were subsequently tested for IgA antiendomysial antibodies (EMA). All subjects who were positive for EMA were advised to undergo an intestinal biopsy and HLA typing.
  
  
  RESULTS
  The study group included 737 women and 239 men, with a median age of 54.3 yr. A positive anti-tTG test was found in 30 out of 976 investigated subjects (3.07%, 95% CI 1.98-4.16). CD was diagnosed in 22 patients (18 women, 4 men). The most frequent reasons for CD screening in these 22 cases were bloating (12/22), thyroid disease (11/22), irritable bowel syndrome (7/22), unexplained chronic diarrhea (6/22), chronic fatigue (5/22), and constipation (4/22). The prevalence of CD in the serologically screened sample was 2.25% (95% CI 1.32-3.18). The diagnostic rate was low at baseline (0.27 cases per thousand visits, 95% CI 0.13-0.41) and significantly increased to 11.6 per thousand visits (95% CI 6.8-16.4, P < 0.001) following active screening implementation.
  
  
  CONCLUSIONS
  This study demonstrates that an active case-finding strategy in the primary care setting is an effective means to improve the diagnostic rate of CD in North America.
authors.affiliation: Mucosal Biology Research Center and Division of Pediatric Gastroenterology and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
authors.forename: Carlo
authors.initials: C
authors.lastname: Catassi
authors.forename: Deborah
authors.initials: D
authors.lastname: Kryszak
authors.forename: Otto
authors.initials: O
authors.lastname: Louis-Jacques
authors.forename: Donald R
authors.initials: DR
authors.lastname: Duerksen
authors.forename: Ivor
authors.initials: I
authors.lastname: Hill
authors.forename: Sheila E
authors.initials: SE
authors.lastname: Crowe
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Brown
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Procaccini
authors.forename: Brigid A
authors.initials: BA
authors.lastname: Wonderly
authors.forename: Paul
authors.initials: P
authors.lastname: Hartley
authors.forename: James
authors.initials: J
authors.lastname: Moreci
authors.forename: Nathan
authors.initials: N
authors.lastname: Bennett
authors.forename: Karoly
authors.initials: K
authors.lastname: Horvath
authors.forename: Margaret
authors.initials: M
authors.lastname: Burk
authors.forename: Alessio
authors.initials: A
authors.lastname: Fasano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000888:Antibodies, Anti-Idiotypic / Q000032:analysis; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D004247:DNA / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006683:HLA-DQ Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology; D015994:Incidence; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D010821:Physicians, Family / Q000592:standards; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D011503:Transglutaminases / Q000276:immunology
chemical_list: D000888:Antibodies, Anti-Idiotypic; D006683:HLA-DQ Antigens; C053186:HLA-DQ2 antigen; C109756:HLA-DQ8 antigen; D007070:Immunoglobulin A; D004247:DNA; D011503:Transglutaminases