Coeliac disease in primary care: case finding study

BMJ 1999;318:164-167 ( 16 January )

General Practice

Coeliac disease in primary care: case finding study

Harold Hin, general practitioner, ^a Graham Bird, Peter Fisher, consultant physician, ^b Nick Mahy, consultant histopathologist, ^b Derek Jewell, consultant gastroenterologist. ^c

^a Hightown Surgery, Banbury OX16 9DB, ^b Horton Hospital, Banbury OX16 9AL, ^c Radcliffe Infirmary, Oxford OX2 6HE

Correspondence to: Dr Hin HaroldHin{at}pgec-horton.demon.co.uk

Objectives: To provide evidence of underdiagnosis of coeliacdisease and to describe the main presenting symptoms of coeliacdisease in primarycare.
Design: Case finding in a primary care setting bytesting for coeliac disease by using the endomysial antibodytest.
Setting: Nine surgeries in and around a market townin central England, serving a population of 70000.
Participants: First 1000 patients screened from October1996 to October1997.
Outcome measures: Determination of endomysial antibody titreof patients fulfilling the study criteria, followed by small intestinebiopsy of those with positiveresults.
Results: The 30 patients (out of 1000 samples) withpositive results on the endomysial antibody test all had histologicalconfirmation on small intestine biopsy. The commonest mode ofpresentation (15/30) was anaemia of varying severity. Most patients(25/30) presented with non-gastrointestinal symptoms. Specificityof the endomysial antibody test was 30/30.
Conclusions: Underdiagnosis and misdiagnosis of coeliacdisease are common in general practice and often result in protractedand unnecessary morbidity. Serological screening in primary carewill uncover a large proportion of patients with this conditionand should be made widely available and publicised. Coeliac diseaseshould be considered in patients who have anaemia or are tiredall the time, especially when there is a family history of thedisease.

Key messages

General practitioners currently see many people with undiagnosed coeliac disease
The most likely presentation is a combination of microcytic anaemia, past or present, a family history of the disease, and feeling tired all the time
Estimations of endomysial antibody and IgA are reliable diagnostic tools
The prevalence of coeliac disease in Britain is higher than the accepted figure of 1:1000 population
Increased awareness of the extra intestinal manifestations of coeliac disease, coupled with a low threshold for serological testing, will uncover a large portion of undiagnosed coeliac disease

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