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General Practice

Coeliac disease in primary care: case finding study

BMJ 1999; 318 doi: (Published 16 January 1999) Cite this as: BMJ 1999;318:164

This article has a correction. Please see:

  1. Harold Hin, general practitioner (HaroldHin{at},
  2. Graham Bird, consultant physicianb,
  3. Fisher Peter, consultant physicianb,
  4. Nick Mahy, consultant histopathologistb,
  5. Derek Jewell, consultant gastroenterologistc
  1. aHightown Surgery, Banbury OX16 9DB
  2. bHorton Hospital, Banbury OX16 9AL
  3. cRadcliffe Infirmary, Oxford OX2 6HE
  1. Correspondence to: Dr Hin
  • Accepted 6 October 1998


Objectives: To provide evidence of underdiagnosis of coeliac disease and to describe the main presenting symptoms of coeliac disease in primary care.

Design: Case finding in a primary care setting by testing for coeliac disease by using the endomysial antibody test.

Setting: Nine surgeries in and around a market town in central England, serving a population of 70 000.

Participants: First 1000 patients screened from October 1996 to October 1997.

Outcome measures: Determination of endomysial antibody titre of patients fulfilling the study criteria, followed by small intestine biopsy of those with positive results.

Results: The 30 patients (out of 1000 samples) with positive results on the endomysial antibody test all had histological confirmation on small intestine biopsy. The commonest mode of presentation (15/30) was anaemia of varying severity. Most patients (25/30) presented with non-gastrointestinal symptoms. Specificity of the endomysial antibody test was 30/30.

Conclusions: Underdiagnosis and misdiagnosis of coeliac disease are common in general practice and often result in protracted and unnecessary morbidity. Serological screening in primary care will uncover a large proportion of patients with this condition and should be made widely available and publicised. Coeliac disease should be considered in patients who have anaemia or are tired all the time, especially when there is a family history of the disease.


    • Accepted 6 October 1998
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