Health Care Providersʼ Knowledge About Celiac Disease

Abstract

Purpose: Celiac disease (CD) is estimated to occur in ∼1% of the United States population, however, the disease remains mostly undiagnosed. The reasons for this are unclear, though it may be due to lack of knowledge about CD among medical practitioners. Methods: We administered an eleven question survey to internal medicine residents and attendings and gastroenterology fellows and attendings at a large university medical center, and to family practice physicians in New York State. The questionnaire included questions about the prevalence, associated conditions and presenting symptoms, diagnosis, and management of CD. Results: 325 questionnaires were completed. The average scores for the different groups were: interns 40.0%, junior residents 46.5%, senior residents 52.9%, internal medicine attendings 54.6%, gastroenterology fellows 65.4%, gastroenterology attendings 66.2%, and family practice physicians 46.4%. Analysis of variance demonstrated that the overall test scores differed significantly among the seven groups (P < .001). GI attendings and GI fellows scores were statistically equivalent, but differed significantly from those of IM residents and attendings and family practice attendings, therefore gastroenterologists were compared to IM/family practice physicians for comparisons based on level of training. Only 19% of respondents knew the prevalence of CD in the U.S. There was a significant association between level of training and knowledge of the prevalence of CD (P= 0.002). 35% of respondents answered that IgA tissue transglutaminase or IgA endomysial antibodies were the most sensitive and specific diagnostic tests. Again, there was a significant association based on level of training (P= < 0.0001). Gastroenterologists also scored better on the questions that asked about associated diseases, lab abnormalities, and extraintestinal manifestations of CD. However, there was no difference in knowledge of GI symptomatology of CD between the groups. See Table 1 for full results.Table 1: Individual Group's Score for Each TopicConclusion: The overall knowledge about CD is poor, even among gastroenterologists, though is more pronounced in non-gastroenterologists. Level of knowledge of diagnostic testing and prevalence are associated with level of training, while knowledge of clinical presentations is not. Unless there are more efforts to increase knowledge of CD among all medical practitioners, especially primary care providers, the disease will continue to be underrecognized.