Abstract
Background Coeliac disease affects 1% of the population, but 75% remain undiagnosed. Objective To conduct a case finding feasibility and efficacy study for the detection of coeliac disease in community pharmacies. Setting Six community pharmacies across Sheffield, UK. Method A prospective study was performed using a point of care test, Simtomax® (IgA/IgG-deamidated gliadin peptide) (C-test) in pharmacies. Pharmacy customers with symptoms suggestive of or risk factors for coeliac disease were tested with the C-test. Positive individuals were referred for a gastroscopy with duodenal biopsies alongside conventional serology. People with known coeliac disease, those on a gluten free diet or those who were investigated for coeliac disease were excluded. Main outcome measure The case detection rate and the uptake rate of the C-test and gastroscopies. Results Five-hundred participants fulfilled the inclusion criteria and were tested with the C-test (369 females, 73.8%; age range 18–87, median 49). The C-test uptake rate was 63%, and the positive rate was 7.2% (36/500). Twenty-seven positive participants (75%) underwent further investigations, confirming three new cases of coeliac disease (0.6%). Conclusion It was feasible to use the C-test as a case finding tool in pharmacies. There was good uptake for the C-test, although the case detection rate and the test specificity were low. Based on this, the C-test has a limited role in case finding in a community pharmacy setting.
Highlights
ObjectiveTo conduct a case finding feasibility and efficacy study for the detection of coeliac disease in community pharmacies
Coeliac disease affects 1% of the population, but 75% remain undiagnosed
Community pharmacies could potentially provide a unique opportunity to recognise undiagnosed coeliac disease in primary care with the help of community pharmacists. It has previously been shown the deamidated gliadin peptide (DGP) based point of care test, Simtomax®1 (C-test), had comparable diagnostic performance to conventional serology (IgA-endomysial [EMA] and IgA-tissue transglutaminase [TTG] antibodies) [17]. This finger prick point of care test offers an additional advantage of rapid result availability within 10 minutes, which makes it ideal to be used in a community setting
Summary
To conduct a case finding feasibility and efficacy study for the detection of coeliac disease in community pharmacies. Pharmacy customers with symptoms suggestive of or risk factors for coeliac disease were tested with the C-test. Main outcome measure The case detection rate and the uptake rate of the C-test and gastroscopies. The C-test uptake rate was 63%, and the positive rate was 7.2% (36/500). Twenty-seven positive participants (75%) underwent further investigations, confirming three new cases of coeliac disease (0.6%). There was good uptake for the C-test, the case detection rate and the test specificity were low. The C-test has a limited role in case finding in a community pharmacy setting. Keywords Case detection · Coeliac disease · Community pharmacy · Deaminated gliadin peptide · DGP · Point of care test · Primary care · Simtomax®
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