title: A case-control study of presentations in general practice before diagnosis of coeliac disease.
abstract: BACKGROUND
  Delay in the diagnosis of coeliac disease prolongs morbidity and may increase mortality. Little is known about presentations in general practice that may predict a subsequent diagnosis of coeliac disease.
  
  
  OBJECTIVE
  To examine presentations in general practice during the 5 years prior to diagnosis of coeliac disease.
  
  
  METHODS
  A case-control study with each biopsy-proven coeliac disease case matched by age, sex, and general practice to an average of two controls.
  
  
  METHODS
  Thirty-seven general practices in south-east Wales.
  
  
  METHODS
  Cases were identified via a secondary care clinic and controls recruited from the general practices of cases. General practice clinical records of both cases and controls were analysed to determine frequency of consultations, presenting symptoms, diagnoses, referrals, and investigations during the 5 years prior to diagnosis.
  
  
  RESULTS
  Cases (n = 68) had an increased number of consultations compared with controls (n = 160) during the 5 years prior to diagnosis (mean difference five consultations, P = 0.001). Three clinical features were independently associated with subsequent diagnosis of coeliac disease: depression and/or anxiety (odds ratio [OR] = 2.5, 95% confidence interval [CI] = 1.1 to 5.7, P = 0.031); diarrhoea (OR = 4.5, 95% CI = 2.0 to 10.0, P <0.001); and anaemia (OR = 26.3, 95% CI = 5.7 to 120.6, P <0.001). Both diarrhoea and anaemia remained associated even when data for the year prior to diagnosis was excluded from the analysis.
  
  
  CONCLUSIONS
  [corrected] GPs should consider testing for coeliac disease when patients present often, especially with diarrhoea and/or who are discovered to be anaemic. Further research is required to clarify the role of depression and/or anxiety in the diagnosis of coeliac disease.
authors: Department of Primary Care and Public Health, Centre for Health Sciences Research, Cardiff University, Cardiff. canningsrl@cardiff.ac.uk
authors: Rebecca
authors: R
authors: Cannings-John
authors: Christopher C
authors: CC
authors: Butler
authors: Hayley
authors: H
authors: Prout
authors: Diane
authors: D
authors: Owen
authors: Della
authors: D
authors: Williams
authors: Kerenza
authors: K
authors: Hood
authors: Rosemary
authors: R
authors: Crimmins
authors: Gillian
authors: G
authors: Swift
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000150:complications*; D001008:Anxiety Disorders / Q000150:complications*; D016022:Case-Control Studies; D002446:Celiac Disease / Q000175:diagnosis* / Q000523:psychology; D003866:Depressive Disorder / Q000150:complications*; D003967:Diarrhea / Q000150:complications*; D042241:Early Diagnosis; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012017:Referral and Consultation; D014852:Wales
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