Celiac disease diagnosis: impact of guidelines on medical prescription in France.
OBJECTIVE
Celiac disease is a complex autoimmune disease affecting patients of any age, who may present a wide variety of clinical manifestations. Different guidelines for the diagnosis and management of celiac disease have been recently published. The aim of this study was to determine whether the recommendations issued in these guidelines have been adopted by physicians in France when celiac disease was suspected.


METHODS
A total of 5521 physicians were asked to fill in a detailed questionnaire on diagnosing celiac disease to evaluate their medical practice, as to the type of symptoms leading to the suspicion of celiac disease, the prescription of duodenal biopsy or serological tests, the type of serological tests (anti-tissue transglutaminase, anti-endomysium, anti-gliadin and anti-reticulin antibodies, total immunoglobulin A measurement) prescribed to diagnose celiac disease.


RESULTS
The analysis of the responses of 256 general practitioners (GPs), 221 gastroenterologists and 227 pediatricians showed that the protean clinical presentations of celiac disease might be better recognized by gastroenterologists and pediatricians than by GPs. Gastroenterologists asked for duodenal biopsy much more often than GPs and pediatricians when celiac disease was suspected. Serological testing and knowledge of critical markers, prescribed to diagnose celiac disease, differed among GPs, gastroenterologists and pediatricians.


CONCLUSIONS
Analysis of medical prescriptions showed that the recommendations for celiac disease diagnosis are not necessarily followed by physicians, emphasizing the fact that the impact of national or international guidelines on medical behavior should be evaluated.
Department of Immunology, CHU Reims, Reims, France.
Bach Nga
BN
Pham
Lucile
L
Musset
Georges
G
Chyderiotis
Nils Olivier
NO
Olsson
Nicole
N
Fabien
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002446:Celiac Disease / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003938:Diagnostic Techniques, Digestive System / Q000706:statistics & numerical data; D005194:Family Practice / Q000592:standards / Q000706:statistics & numerical data; D005602:France; D005762:Gastroenterology / Q000592:standards / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D010372:Pediatrics / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D055656:Prescriptions / Q000592:standards / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012698:Serologic Tests / Q000706:statistics & numerical data; D055815:Young Adult
anti-endomysium antibody; anti-tissue transglutaminase antibody; celiac disease; duodenal biopsy; guideline; questionnaire