title: Case-finding for coeliac disease in secondary care: a prospective multicentre UK study.
abstract: BACKGROUND
  Coeliac disease affects 1% of the population. Despite this high prevalence, the majority of individuals are undetected. Many patients present with subtle symptoms which may also contribute to under diagnosis. Our aim was to determine the relative importance of different presenting characteristics.
  
  
  METHODS
  Unselected gastroenterology patients referred to 4 hospitals in South Yorkshire were investigated for coeliac disease. Diagnosis was based on positive serology and the presence of villous atrophy. Odds ratios were calculated for presenting characteristics and multivariate analysis performed to identify independent risk factors.
  
  
  RESULTS
  4089 patients were assessed (41.5% male, mean age 55.8 ± 18.2 years); 129 had coeliac disease (3.2%, 95% CI 2.6-3.7%). Multivariate analysis of patients referred to secondary care showed family history of coeliac disease (OR 1.26, p < 0.0001), anaemia (OR 1.03, p < 0.0001) and osteoporosis (OR 1.1, p = 0.006) were independent risk factors for diagnosis of coeliac disease. When compared to population controls, diarrhoea (OR 4.1, p < 0.0001), weight loss (OR 2.7, p = 0.02), irritable bowel syndrome symptoms (OR 3.2, p = 0.005) thyroid disease (OR 4.4, p = 0.01) and diabetes (OR 3.0, p = 0.05) were also associated with increased coeliac disease risk.
  
  
  CONCLUSIONS
  Coeliac disease accounts for 1 in 31 referrals in secondary care to unselected gastroenterology clinics. A low threshold for coeliac disease testing should be adopted.
authors.affiliation: Gastroenterology & Liver Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2JF, UK. Electronic address: peter.mooney@sth.nhs.uk.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Mooney
authors.affiliation: Department of Gastroenterology, Aberdeen Royal Infirmary, Forester Hill Road, Aberdeen, AB25 2ZN, UK.
authors.forename: John S
authors.initials: JS
authors.lastname: Leeds
authors.affiliation: Department of Gastroenterology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
authors.forename: Nafan
authors.initials: N
authors.lastname: Libzo
authors.affiliation: Gastroenterology & Liver Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2JF, UK.
authors.forename: Reina
authors.initials: R
authors.lastname: Sidhu
authors.affiliation: Gastroenterology & Liver Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2JF, UK.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Evans
authors.affiliation: Gastroenterology & Liver Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2JF, UK.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Hall
authors.affiliation: Gastroenterology & Liver Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2JF, UK.
authors.forename: Veerinder S
authors.initials: VS
authors.lastname: Jandu
authors.affiliation: Gastroenterology & Liver Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2JF, UK.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Hopper
authors.affiliation: Department of Gastroenterology, Department of Gastroenterology, Rotherham District General Hospital, Moorgate Road, Rotherham, S60 2UD, UK.
authors.forename: Pandurangan
authors.initials: P
authors.lastname: Basumani
authors.affiliation: Department of Gastroenterology, Chesterfield Royal Hospital, Calow, Chesterfield, S44 5BL, UK.
authors.forename: Keith L
authors.initials: KL
authors.lastname: Dear
authors.affiliation: Gastroenterology & Liver Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2JF, UK.
authors.forename: Mark E
authors.initials: ME
authors.lastname: McAlindon
authors.affiliation: Gastroenterology & Liver Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2JF, UK.
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology*; D002446:Celiac Disease / Q000175:diagnosis / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D003967:Diarrhea / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010024:Osteoporosis / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D063127:Secondary Health Care; D013959:Thyroid Diseases / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology; D015431:Weight Loss; D055815:Young Adult
keywords: Case-finding; Coeliac disease