title: Do gastroenterologists adhere to diagnostic and treatment guidelines for celiac disease?
abstract: OBJECTIVE
  Our group hypothesized that significant variation exists between suggested clinical guidelines, the clinical practices of practicing gastroenterologists and academic experts in celiac disease (CD).
  
  
  METHODS
  We designed 4 CD vignettes comparing experts and practicing gastroenterologists. Practicing gastroenterologists (n=169) were surveyed during Digestive Disease Week 2009 and experts (n=22) answered e-mail surveys. Ratings for answers in each vignette was done using a 9-point RAND Appropriateness Scale (RAS) with endorsement defined as RAS score of 7 to 9. We also calculated the RAND "Disagreement Index" (DI) was calculated, with DI>1.0 indicated extreme variation.
  
  
  RESULTS
  A total of 169 practicing gastroenterologists and 22 experts were included. Differences in all vignette answers were present. Differences were seen for use of IgA anti-endomysial antibodies (P=0.0241), human leukocyte antigen DQ2/8 testing (P=0.0325), gluten challenge (P<0.0001), and oat consumption (P<0.0001). There were differences in recommendations for biopsy review (P=0.0479) and management of dermatitis herpetiformis (P=0.0025). Experts consistently endorsed CD screening in patients with type 1 diabetes, Down and Turner syndromes, and relatives of CD patients compared with practicing physicians (P=0.0054, 0.0003, <0.0001, 0.0304). Experts endorsed CD screening for atypical presentations (delayed puberty, elevated transaminases, primary biliary cirrhosis, autoimmune hepatitis, and infertility).
  
  
  CONCLUSIONS
  There is significant disagreement between nonexperts and experts in diagnosis and management of CD. Promotion of existing guidelines and further research is advised.
authors.affiliation: Department of Internal Medicine, University of Chicago (NorthShore) program, Chicago, IL 60035, USA.
authors.forename: Deepak
authors.initials: D
authors.lastname: Parakkal
authors.forename: Hongyan
authors.initials: H
authors.lastname: Du
authors.forename: Rumi
authors.initials: R
authors.lastname: Semer
authors.forename: Eli Daniel
authors.initials: ED
authors.lastname: Ehrenpreis
authors.forename: Stefano
authors.initials: S
authors.lastname: Guandalini
mesh_terms: D000328:Adult; D002446:Celiac Disease / Q000175:diagnosis / Q000628:therapy; D019468:Disease Management; D005260:Female; D005762:Gastroenterology / Q000592:standards*; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic