Awareness of Physicians on Celiac Disease and the Effect of Education

Abstract

Celiac disease is a genetic in origin, systemic autoimmune disease that can be occur at any stage of life. The onset of the disease is triggered by dietary intake of wheat, barley and rye containing gluten prolamins. The prevalence of the disease is around 1% and this rate is expected to increase as awareness increases. Due to celiac disease mimicking the symptoms of other diseases and being known as a rare disease, the diagnosis rate is low, and patients are often diagnosed late. In this study, we evaluated the awareness rates of physicians and investigated the effect of celiac training on awareness rate. Our research is a pre-test and post-test compatibility study prepared in cross-sectional style. Family physicians who participated in the meeting on May 9, 2019, Celiac Day were included in our study. The pre-test was distributed to physicians just before the meeting. A training module on celiac disease was presented to the participants and a final test was performed afterwards. When the pre-test and post-test were matched, the questionnaires of 88 physicians were analyzed. Kappa coefficient was calculated for nominal scale information and Kendall’s tau-b correlation coefficient for ordinal scale questions were calculated. A binary logistic regression model was created according to the situation of encountering celiac patients in the study environment. In the whole study, type-I error value was taken as 5% and p<0.05 value was accepted as statistically significant. The mean age of the participants was 30.91±6.69 years. The mean number of patients suspected of celiac disease was 3.13 in the participants who stated that they had seen 767 patients in a month. The mean for patients diagnosed with celiac disease was 1.56 in the last year. When celiac-related conditions are evaluated, the states with the highest awareness are chronic diarrhea (100%), weight loss (98.9%), and anemia (96.6%), respectively, while the least common conditions were genetic syndromes (14.8-20.5%) and gynecological problems and infertility (39.8-42%). In the last test after the training, it was found that almost all the awareness was around 90%. The change between pre-test and post-test was significant for most statements (p<0.001). When the comparisons between the pre-test and post-test on the self-sufficient visual scale provided to the physicians were made, the difference was observed as significant in both (Wilcoxon test, p <0.001). Chronic diarrhea, weight loss, anemia, and dyspepsia were the most well-known conditions related to celiac disease in our study, while gynecological problems and genetic syndromes were the least known. It was determined that typical celiac disease is known more, and atypical celiac disease is less known. At the end of the training, it was observed that the awareness rate increased in all findings. The results of the study support that reminding of celiac disease with in-service training given both in residency training and in primary care can increase the diagnosis rates.