Coeliac disease in primary care: case finding study

This study took 1000 consecutive patients presenting to a GP surgery and screened them for coeliac disease (1):

• setting:
  • nine surgeries in and around a market town in central England, serving a population of 70 000.
• participants:
  • first 1000 patients screened from October 1996 to October 1997criteria for inclusion in the screening process were defined as:
    • • irritable bowel syndrome;
      • anaemia (haemoglobin <115 g/l in female patients and <120 g/l in male patients;
      • family history of coeliac disease;
      • malabsorption symptoms or diarrhoea;
      • fatigue or “tired all the time”; thyroid disease or diabetes;
      • weight loss, short stature, or failure to thrive;
      • epilepsy, infertility, arthralgia, or eczema
    • list of criteria was derived from a literature search (done through Medline) and takes into consideration the different modes of presentation possible in a general practice setting
• outcome measures:
  • determination of endomysial antibody titre of patients fulfilling the study criteria, followed by small intestine biopsy of those with positive results.
• results:
  • 30 patients (out of 1000 samples) with positive results on the endomysial antibody test all had histological confirmation on small intestine biopsy
  • commonest mode of presentation (15/30) was anaemia of varying severity
  • most patients (25/30) presented with non-gastrointestinal symptoms.
  • specificity of the endomysial antibody test was 30/30

3% of the patients had positive anti-endomysial antibodies detected and all of these had the diagnosis of coeliac disease confirmed by duodenal biopsy.

Patients who present to their GP with the following risk factors should be screened serologically for coeliac disease:

• anaemia
• tired all the time
• family history of coeliac disease

Reference:

1. Hin H, Bird G, Fisher P, Mahy N, Jewell D. Coeliac disease in primary care: case finding study. BMJ. 1999 Jan 16;318(7177):164-7.