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India should worry about underdiagnosis and overdiagnosis of coeliac disease

BMJ 2014; 348 doi: (Published 19 March 2014) Cite this as: BMJ 2014;348:g2046
  1. Pankaj Vohra, senior consultant, pediatric gastroenterology, Max Super Speciality Hospital, Press Enclave Marg, Saket, Delhi 110021, India
  1. pankajvohramd{at}

Lack of awareness means patients are being let down, says Pankaj Vohra

As a paediatric gastroenterologist in Delhi, having seen more than 1000 cases of coeliac disease in the past 15 years, I am concerned about both underdiagnosis and overdiagnosis.1

Underdiagnosis is common in adults and in children from most of the so called hinterland, primarily because of limited awareness. Coeliac disease was not taught in medical schools until recently, and India has no standard re-certification process. For most doctors, diarrhoea means infection and, if recurrent, either reinfection or in some cases intestinal tuberculosis. It also does not help that coeliac disease has so many manifestations, especially extraintestinal. And often if a doctor can’t “fix” a patient in a day or two, or does not prescribe antibiotics, the patient will go to another doctor. This so called shopping for a cure can delay diagnosis further. Also, many children are seen by general physicians who are not attuned to looking for growth problems, which is an important marker for coeliac disease.

Conversely, there are pockets in India, mostly in the northern cities of the wheat eating belt, where awareness …

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