title: Italian family paediatricians' approach and management of celiac disease: a cross-sectional study in Puglia Region, 2012.
abstract: BACKGROUND
  Celiac disease (CD) is a chronic autoimmune illness of the small intestine triggered by gluten consumption in genetically predisposed individuals. CD presentation is not limited to the gastrointestinal tract and it is still under-diagnosed. Complete resolution of clinical manifestations follows if a gluten-free diet is adopted. In western countries, CD prevalence is approximately 1%. Age of onset is often between 6 months and 7 years.We assessed the approach to diagnosis and management of celiac patients by the paediatricians in Puglia Region, Italy.
  
  
  METHODS
  We conducted a cross-sectional survey among the 589 Apulian Family Paediatricians (FPs) during January 2011-January 2012 using a self-administered web-based standardized questionnaire including self-assessment of their knowledge, diagnostic path and type of management they would follow for CD, clinical information on their celiac patients. We assessed associations among the explored variables by defining double-entry contingency tables and calculating Odds Ratio (OR) with 95% Confidence Intervals (CIs).
  
  
  RESULTS
  The 218 (37%) FPs participating in the study reported 1,020 CD patients (representing approximately 1% of the child population covered by the enrolled FPs). Of them, 55% were female; 45% were aged 5-10 years. Weight loss and stunting were the main reported symptoms at diagnosis (41%). The majority (98%) of FPs requested anti-transglutaminase antibody (tTG-Ab) titres for CD diagnosis. Approximately 78% of FPs recommended gluten introduction in the diet of infants at the age of 6 months; 12% and 8% recommended introduction of gluten before and after 6 months of age respectively.The degree of knowledge for either CD diagnosis making process or CD related diseases was medium/high in 97% and 82% of the participating FPs respectively. FPs (83%) who had a medium or high degree of knowledge of CD patients' diet were more likely to experience low or no difficulty in providing their patients with dietary advices (OR:5.5; 95%CI:1.7-17.5).
  
  
  CONCLUSIONS
  Apulian FPs report a good degree of knowledge of CD, its diagnosis and its management. We will diffuse results and recommendations to all paediatricians in the Region. Actions aiming to continued education on CD in medical under and postgraduate trainings are crucial to prevent under-diagnosis.
authors.forename: Francesca
authors.initials: F
authors.lastname: Fortunato
authors.forename: Domenico
authors.initials: D
authors.lastname: Martinelli
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cozza
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Ciavarella
authors.forename: Anna
authors.initials: A
authors.lastname: Valente
authors.forename: Teresa
authors.initials: T
authors.lastname: Cazzato
authors.forename: Ruggiero
authors.initials: R
authors.lastname: Piazzolla
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71100 Foggia, Italy. rosa.prato@unifg.it.
authors.forename: Rosa
authors.initials: R
authors.lastname: Prato
authors.forename: Biagio
authors.initials: B
authors.lastname: Pedalino
mesh_terms: D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis* / Q000178:diet therapy; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D055050:Diet, Gluten-Free; D037001:Directive Counseling; D005260:Female; D019204:GTP-Binding Proteins; D005903:Gliadin / Q000276:immunology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010372:Pediatrics / Q000379:methods*; D010818:Practice Patterns, Physicians'; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012698:Serologic Tests; D011795:Surveys and Questionnaires; D011503:Transglutaminases / Q000276:immunology
chemical_list: D000906:Antibodies; D005903:Gliadin; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins