title: Use of health care services and pharmaceutical agents in coeliac disease: a prospective nationwide study.
abstract: BACKGROUND
  Approximately 1% of the population suffer from coeliac disease. However, the disease is heavily underdiagnosed. Unexplained symptoms may lead to incremented medical consultations and productivity losses. The aim here was to estimate the possible concealed burden of untreated coeliac disease and the effects of a gluten-free diet.
  
  
  METHODS
  A nationwide cohort of 700 newly detected adult coeliac patients were prospectively evaluated. Health care service use and sickness absence from work during the year before diagnosis were compared with those in the general population; the data obtained from an earlier study. Additionally, the effect of one year on dietary treatment on the aforementioned parameters and on consumption of pharmaceutical agents was assessed.
  
  
  RESULTS
  Untreated coeliac patients used primary health care services more frequently than the general population. On a gluten-free diet, visits to primary care decreased significantly from a mean 3.6 to 2.3. The consumption of medicines for dyspepsia (from 3.7 to 2.4 pills/month) and painkillers (6.8-5.5 pills/month) and the number of antibiotic courses (0.6-0.5 prescriptions/year) was reduced. There were no changes in hospitalizations, outpatient visits to secondary and tertiary care, use of other medical services, or sickness absence, but the consumption of nutritional supplements increased on treatment.
  
  
  CONCLUSIONS
  Coeliac disease was associated with excessive health care service use and consumption of drugs before diagnosis. Dietary treatment resulted in a diminished burden to the health care system and lower use of on-demand medicines and antibiotic treatment. The results support an augmented diagnostic approach to reduce underdiagnosis of coeliac disease.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01145287.
authors.affiliation: School of Medicine, FinnMedi3, University of Tampere, FIN-33014, Tampere, Finland.
authors.forename: Anniina
authors.initials: A
authors.lastname: Ukkola
authors.forename: Kalle
authors.initials: K
authors.lastname: Kurppa
authors.forename: Pekka
authors.initials: P
authors.lastname: Collin
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.forename: Leena
authors.initials: L
authors.lastname: Forma
authors.forename: Leila
authors.initials: L
authors.lastname: Kekkonen
authors.forename: Markku
authors.initials: M
authors.lastname: Mäki
authors.forename: Katri
authors.initials: K
authors.lastname: Kaukinen
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000191:economics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D002446:Celiac Disease / Q000175:diagnosis / Q000178:diet therapy / Q000188:drug therapy* / Q000191:economics; D015331:Cohort Studies; D055050:Diet, Gluten-Free / Q000191:economics / Q000706:statistics & numerical data; D019587:Dietary Supplements / Q000191:economics / Q000706:statistics & numerical data; D004415:Dyspepsia / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D005260:Female; D005387:Finland; D005765:Gastrointestinal Agents / Q000191:economics / Q000627:therapeutic use*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000700:Analgesics; D000900:Anti-Bacterial Agents; D005765:Gastrointestinal Agents