Celiac Disease Awareness Among Health Care Providers: Diagnosis and Nutritional and Metabolic Deficiencies: Results of an Anonymous Online Survey

Abstract

Introduction: Assess the current awareness of celiac disease diagnosis among healthcare providers. Celiac disease (CD) affects an estimated 1/150-1/200. Previous reports reveal that there is limited awareness of the disease among healthcare providers, leading to a delay in diagnosis of up to 10 years after the onset of symptoms. To diagnose CD, current ACG guidelines recommend duodenal biopsy plus celiac serology when pretest probability of the disease is more than 5%, and celiac serology alone when pretest probability is less than 5%. Methods: Online survey was sent to 450 health care providers in the USA. Eighty responses were obtained. Results: Out of 80 responders, 26 (37%) were PCP, 16 (23%) were GI physicians, 29 (36%) had other specialties (DO, NP, OB); 49% had practiced medicine for more than 5 years. Most responders learned about CD in medical school (65%), residency or other postgraduate training (72%), and continuing medical education (29%). Fifty-three percent of responders treat 10 or fewer patients with CD, while 48% treat more than 10. Eighty-nine percent of responders diagnosed these patients with CD. Since starting their careers, 70% of responders feel their awareness of CD has increased, and 78% are now more likely to consider CD when evaluating patients’ symptoms. When responders were asked to define the first tests they order when they strongly suspect CD, 49 (63%) order celiac serology, 15 (19%) order celiac serology and an endoscopy, 12 (15%) refer to GI for work-up, and 7 (9%) refer directly to a nutritionist to start a gluten-free (GF) diet. Asked to state their recommendations after the diagnosis of CD is made, 71 responders (91%) recommend starting a GF diet. Many also refer CD patients to a nutritionist (53 responders, 68%) and a gastroenterologist (49 responders, 63%). While 80% of the responders check calcium, vitamin D, and iron levels, only 58% check vitamin B12 levels; 52% check TSH. Further, only 37% of responders order a bone mineral density scan, and less than 25% check vitamin K and zinc levels. Conclusion: While most healthcare responders feel their awareness of CD has increased in recent years, there is a lack of consensus regarding the methods used for CD diagnosis and which deficiencies should be investigated.Figure 1