Celiac disease is one of the most common lifelong disorders in western countries.
However, most cases remain currently undiagnosed in North America, mostly due to poor awareness of celiac disease by primary care physicians.
Dr Alessio Fasano and colleagues from Pennsylvania, USA determined whether an active case-finding strategy in primary care could increase the frequency of celiac disease diagnosis.
The research team determined the most common clinical presentations of the condition.
The researchers conducted a multicenter, prospective study involving adult subjects during the years 2002 to 2004, attending one of the participating practices.
All individuals with symptoms or conditions known to be associated with celiac disease were tested for immunoglobulin A anti-transglutaminase antibodies.
|The prevalence of celiac disease in the screened sample was about 2%|
|American Journal of Gastroenterology|
Those with elevated anti-transglutaminase were subsequently tested for immunoglobulin A antiendomysial antibodies.
The team advised all subjects who were positive for antiendomysial antibodies to undergo an intestinal biopsy and HLA typing.
The study group included 737 women and 239 men, with a median age of 54 years.
A positive anti-transglutaminase test was found in 30 out of 976 investigated subjects.
Celiac disease was diagnosed in 22 patients, of which 18 were women.
The most frequent reasons for celiac disease screening in these 22 cases were bloating, thyroid disease, and irritable bowel syndrome.
Unexplained chronic diarrhea, chronic fatigue, and constipation were also reasons for celiac disease screening.
The team found that the prevalence of celiac disease in the serologically screened sample was about 2%.
The team noted that the diagnostic rate was low at baseline, and significantly increased to 12 per thousand visits following active screening implementation.
Dr Fasano's team comments, "This study demonstrates that an active case-finding strategy in the primary care setting is an effective means to improve the diagnostic rate of celiac disease in North America."