title: Coeliac disease screening is suboptimal in a tertiary gastroenterology setting.
abstract: OBJECTIVE
  Coeliac disease (CD) is widely prevalent in North America, but case-finding techniques currently used may not be adequate for patient identification. We aimed to determine the adequacy of CD screening in an academic gastroenterology (GI) practice.
  
  
  METHODS
  Consecutive initial visits to a tertiary academic GI practice were surveyed over a 3-month period as a fellow-initiated quality improvement project. All electronic records were reviewed to look for indications for CD screening according to published guidelines. The timing of screening was noted (before or after referral), as well as the screening method (serology or biopsy). Data were analysed to compare CD screening practices across subspecialty clinics.
  
  
  RESULTS
  616 consecutive patients (49±0.6 years, range 16-87 years, 58.5% females, 94% Caucasian) fulfilled inclusion criteria. CD testing was indicated in 336 (54.5%), but performed in only 145 (43.2%). The need for CD screening was highest in luminal GI and inflammatory bowel disease clinics, followed by biliary and hepatology clinics (p<0.0001); CD screening rate was highest in the luminal GI clinic (p=0.002). Of 145 patients screened, 4 patients (2.4%) had serology consistent with CD, of which 2 were proven by duodenal biopsy. Using this proportion, an additional 5 patients might have been diagnosed in 191 untested patients with indications for CD screening.
  
  
  CONCLUSIONS
  More than 50% of patients in a tertiary GI clinic have indications for CD screening, but <50% of indicated cases are screened. Case-finding techniques therefore are suboptimal, constituting a gap in patient care and an important target for future quality improvement initiatives.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.|Digestive Diseases Division, Department of Medicine, Emory University, Atlanta, Georgia, USA.
authors.forename: Heba
authors.initials: H
authors.lastname: Iskandar
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.|The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Darrell M
authors.initials: DM
authors.lastname: Gray
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.
authors.forename: Hongha
authors.initials: H
authors.lastname: Vu
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.
authors.forename: Faiz
authors.initials: F
authors.lastname: Mirza
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.
authors.forename: Mary Katherine
authors.initials: MK
authors.lastname: Rude
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.
authors.forename: Kara
authors.initials: K
authors.lastname: Regan
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.
authors.forename: Adil
authors.initials: A
authors.lastname: Abdalla
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Gaddam
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.
authors.forename: Sami
authors.initials: S
authors.lastname: Almaskeen
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Mello
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Marquez
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Meyer
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Bolkhir
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.
authors.forename: Navya
authors.initials: N
authors.lastname: Kanuri
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.|John Cochran Veterans Affairs Medical Center, St Louis, Missouri, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Sayuk
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.
authors.forename: C Prakash
authors.initials: CP
authors.lastname: Gyawali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002446:Celiac Disease / Q000453:epidemiology*; D005260:Female; D005762:Gastroenterology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D015995:Prevalence; D012698:Serologic Tests