Physician awareness of celiac disease: a need for further education

• Published in: Journal of general internal medicine : JGIM Vol. 20; no. 7; pp. 644 - 646
• Main Authors: Zipser, Robert D, Farid, Mary, Baisch, Donald, Patel, Bhairavi, Patel, Devika
• Format: Journal Article
• Language: English
• Published: United States 01.07.2005
• Subjects: Awareness; California; Celiac Disease - diagnosis; Clinical Competence; Data Collection; Diagnostic Errors; Humans; Physicians, Family; Professional Practice; Self-Help Groups; Surveys and Questionnaires; California
• ISSN: 1525-1497
• DOI: 10.1111/j.1525-1497.2005.0107.x

Celiac disease is a common disorder (up to 0.7%); however, it is uncommonly diagnosed in the United States. We sought to determine physician awareness of celiac disease. Surveys completed by 2,440 (47%) of 5,191 patients in a support group were analyzed for frequency of diagnosis by physician specialties. Questionnaires were then sent to primary care physicians (PCPs) (n=132) in a southern California county to assess knowledge of celiac disease. In patient surveys, only 11% were diagnosed by PCPs (internists and family physicians) versus 65% by gastroenterologists. Physician surveys (70% response) showed that only 35% of PCPs had ever diagnosed celiac disease. Almost all physicians (95%) knew of wheat intolerance, but few (32%) knew that onset of symptoms in adulthood is common. Physicians were well aware (90%) of diarrhea as a symptom, but fewer knew of common symptoms of irritable bowel syndrome (71%), chronic abdominal pain (67%), fatigue (54%), depression and irritability (24%) or of associations with diabetes (13%), anemia (45%) or osteoporosis (45%), or of diagnosis by endomysial antibody tests (44%). Lack of physician awareness of adult onset of symptoms, associated disorders, and use of serology testing may contribute to the underdiagnosis of celiac disease.