title: Interprovider variation of celiac disease testing in childhood chronic abdominal pain.
abstract: BACKGROUND
  To determine within one tertiary care center: 1) the variation between providers in testing for celiac disease in children with chronic abdominal pain; 2) the characteristics of those children who were more likely to be tested, and 3) the prevalence of celiac disease in those evaluated.
  
  
  METHODS
  Retrospective review of children with a primary complaint of chronic abdominal pain referred to a tertiary care children's hospital for pediatric gastroenterology evaluation over a 2-year period was conducted. Children with at least two visits and without an identified organic etiology for the pain were included.
  
  
  RESULTS
  160 children were evaluated by 16 pediatric gastroenterologists and one nurse practitioner. Celiac serologic testing was completed in 63 (39.4%) children. There was no significant variance in the frequency of celiac serologic testing between providers. Child age, gender, body mass index, and baseline gastrointestinal symptoms did not predict whether celiac serologic testing occurred, though Caucasians (P < 0.01) were more likely to be tested. Eighty-two (51.3%) children underwent either serologic testing and/or esophagogastroduodenoscopy. Four (4.9%, 95% CI: 1.6-11.3%) of the 82 tested were diagnosed with celiac disease.
  
  
  CONCLUSIONS
  Though interprovider variation for celiac disease testing in children with chronic abdominal pain did not occur, a large number of these children were not evaluated for celiac disease. Children's race/ethnicity but not their associated gastrointestinal symptoms predicted whether celiac testing was undertaken. In those tested, celiac disease was identified in a higher percentage than that expected in the general population.
authors.affiliation: Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. chumpita@bcm.edu.
authors.forename: Bruno Pedro
authors.initials: BP
authors.lastname: Chumpitazi
authors.forename: Krupa
authors.initials: K
authors.lastname: Mysore
authors.forename: Cynthia Man-Wai
authors.initials: CM
authors.lastname: Tsai
authors.forename: Robert Jay
authors.initials: RJ
authors.lastname: Shulman
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology; D000293:Adolescent; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D016145:Endoscopy, Digestive System / Q000706:statistics & numerical data; D005260:Female; D005762:Gastroenterology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D012698:Serologic Tests / Q000706:statistics & numerical data; D062606:Tertiary Care Centers