title: Prior Misdiagnosis of Celiac Disease Is Common Among Patients Referred to a Tertiary Care Center: A Prospective Cohort Study.
abstract: OBJECTIVE
  Interest of patients and physicians in celiac disease is growing worldwide, but without a corresponding increase in the awareness of the disease. Many patients are diagnosed as celiacs even without completing the whole diagnostic process, with consequent risk of misdiagnosis and delay in the evaluation of other diseases. The objective of this study was to assess the rates of prior celiac disease misdiagnosis among patients referred to a tertiary care center.
  
  
  METHODS
  From June 2013 to December 2014, we prospectively recruited patients referred for the first time to our Celiac Disease Center. Patients with a previous diagnosis of celiac disease underwent a diagnostic revaluation by second reading of duodenal tissue slides, dosage of specific antibodies, and/or duodenal biopsy sampling; HLA status was investigated in pertinent cases.
  
  
  RESULTS
  A total of 198 subjects were recruited. Of these, 91 "naïve" patients (46%) started the diagnostic screening for celiac disease; 58 of them (64-29% of the whole sample) were diagnosed as celiacs. The remaining 107 patients (54%) came with a previous diagnosis of celiac disease: of these, 52 (49-26% of the whole sample) presented with confirmed diagnosis of celiac disease, whereas 55 (51-28% of the whole sample) underwent diagnostic revaluation. After the reassessment, diagnosis was rejected in 43 cases (78-22% of the whole sample) and confirmed in the remaining 12 (22-6% of the whole sample). Overall, diagnosis was confirmed in only 64 of the 107 subjects with a previous diagnosis (60-32% of the whole sample). Diagnosis of celiac disease was more frequently confirmed in "naïve" patients compared those with a questionable previous diagnosis (64% vs. 22%; P<0.0001).
  
  
  CONCLUSIONS
  A considerable number of patients referred to a tertiary care center are inaccurately diagnosed with celiac disease. Although we cannot exclude that uncertain diagnosis was a reason for the referral, we suggest greater adherence to guidelines to minimize the burden of celiac disease misdiagnosis.
authors.affiliation: Internal Medicine, Gastroenterology and Liver Unit, "A. Gemelli" University Hospital, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Ianiro
authors.affiliation: Internal Medicine, Gastroenterology and Liver Unit, "A. Gemelli" University Hospital, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bibbò
authors.affiliation: Internal Medicine, Gastroenterology and Liver Unit, "A. Gemelli" University Hospital, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Bruno
authors.affiliation: Hystopathology Unit, "A. Gemelli" University Hospital, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ricci
authors.affiliation: Hystopathology Unit, "A. Gemelli" University Hospital, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Arena
authors.affiliation: Internal Medicine, Gastroenterology and Liver Unit, "A. Gemelli" University Hospital, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.affiliation: Internal Medicine, Gastroenterology and Liver Unit, "A. Gemelli" University Hospital, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cammarota
references.citation: Gastroenterology. 2006 Apr;130(5):1466-79
references.pmid: 16678560
references.citation: Aliment Pharmacol Ther. 2010 Jan;31(1):73-81
references.pmid: 19664074
references.citation: Gastroenterology. 2005 Apr;128(4 Suppl 1):S57-67
references.pmid: 15825128
references.citation: Clin Exp Gastroenterol. 2014 Jan 24;7:25-37
references.pmid: 24493932
references.citation: Can J Gastroenterol. 2009 Aug;23(8):543-5
references.pmid: 19668797
references.citation: Soc Sci Med. 2009 Aug;69(4):623-31
references.pmid: 19559513
references.citation: Eur J Gastroenterol Hepatol. 1999 Oct;11(10):1185-94
references.pmid: 10524652
references.citation: Intern Emerg Med. 2014 Apr;9(3):249-56
references.pmid: 24435555
references.citation: Scand J Gastroenterol. 2008;43(11):1311-4
references.pmid: 18609173
references.citation: Int J Immunopathol Pharmacol. 2009 Jan-Mar;22(1):1-7
references.pmid: 19309546
references.citation: Am J Gastroenterol. 2013 May;108(5):656-76; quiz 677
references.pmid: 23609613
references.citation: Acta Gastroenterol Latinoam. 2009 Dec;39(4):250-3
references.pmid: 20178253
references.citation: Am J Gastroenterol. 2007 Jul;102(7):1461-3
references.pmid: 17593160
references.citation: Am J Gastroenterol. 2010 Dec;105(12):2520-4
references.pmid: 21131921
references.citation: Scand J Gastroenterol. 1997 Sep;32(9):917-9
references.pmid: 9299671
references.citation: BMC Med. 2012 Feb 07;10:13
references.pmid: 22313950
references.citation: Ann Med. 2010 Dec;42(8):557-61
references.pmid: 20883139
references.citation: Gut. 2014 Aug;63(8):1210-28
references.pmid: 24917550
references.citation: Gastroenterology. 2006 Apr;130(5):1480-91
references.pmid: 16678561
references.citation: US News World Rep. 2008 Dec 1-8;145(12):66, 68
references.pmid: 19606737
references.citation: World J Gastroenterol. 2013 Dec 14;19(46):8562-70
references.pmid: 24379573
references.citation: Aliment Pharmacol Ther. 2007 Nov 1;26(9):1217-25
references.pmid: 17944736
references.citation: BMC Med. 2014 May 23;12:85
references.pmid: 24885375