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Coeliac disease screening is suboptimal in a tertiary gastroenterology setting
  1. Heba Iskandar1,2,
  2. Darrell M Gray II1,3,
  3. Hongha Vu1,
  4. Faiz Mirza1,
  5. Mary Katherine Rude1,
  6. Kara Regan1,
  7. Adil Abdalla1,
  8. Srinivas Gaddam1,
  9. Sami Almaskeen1,
  10. Michael Mello1,
  11. Evelyn Marquez1,
  12. Claire Meyer1,
  13. Ahmed Bolkhir1,
  14. Navya Kanuri1,
  15. Gregory Sayuk1,4,
  16. C Prakash Gyawali1
  1. 1 Division of Gastroenterology, Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA
  2. 2 Digestive Diseases Division, Department of Medicine, Emory University, Atlanta, Georgia, USA
  3. 3 The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  4. 4 John Cochran Veterans Affairs Medical Center, St Louis, Missouri, USA
  1. Correspondence to Dr Heba Iskandar, Digestive Diseases Division, Department of Medicine, Emory University, 1365 Clifton Rd NE Bldg B, Atlanta, GA 30322, USA; heba.iskandar{at}


Background and aims 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.

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  • Contributors HI: study design, data management, statistical analysis, manuscript writing and revision; DMG, HV, FM, MKR, KR, AA, SG, SA, MM, EM, CM, AB and NK: data collection and database entry, revision of manuscript; GS: critical revision of the manuscript and CPG: study design, study oversight, manuscript writing and critical revision. Guarantors of the paper: HI and CPG.

  • Funding HI: 5T32DK007130-36, UL1TR000448; GS: K23 DK084113.

  • Competing interests None declared.

  • Ethics approval Washington University in St Louis Human Research Protection Office.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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