Silvester Jocelyn Anne, Rashid Mohsin
Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia.
Can J Gastroenterol. 2010 Aug;24(8):499-509. doi: 10.1155/2010/140289.
Long-term follow-up of patients with celiac disease is important for monitoring their clinical status, dietary compliance and complications.
To examine the current practices of Canadian gastroenterologists providing long-term care to patients with celiac disease.
All gastroenterologists in Canada (n=585) were surveyed regarding their practice demographics, familiarity with celiac disease practice guidelines, and follow-up clinical examination and investigations.
Of the 585 surveys mailed to gastroenterologists, 567 were expected to be returned. A total of 242 completed surveys (43%) were received. Of these, 237 (184 adult, 51 pediatric and two mixed) had an active practice that included patients with celiac disease. Long-term follow-up care was provided routinely by 76% of respondents. Follow-up consisted of annual clinic visits (67%), dietary review (77%), reinforcement of the need for adherence to a gluten-free diet (90%) and recommending membership in an advocacy group (65%). Physical examination was performed by 78%; most ordered laboratory tests including serology (65%).Adult gastroenterologists performed routine follow-up intestinal biopsy more often than their pediatric counterparts (46% versus 10%), but performed serology less frequently (48% versus 86%). Pediatric patients were more likely to be followed by a multidisciplinary team. All pediatric gastroenterologists were familiar with at least one celiac disease practice guideline, whereas 15% of adult gastroenterologists were not familiar with any practice guideline. The majority of gastroenterologists who did not routinely provide follow-up expected care to be provided by the patient's primary physician (86%).
Most gastroenterologists in Canada who responded to the survey provided long-term follow-up care to patients with celiac disease. The diverse practices reported underscore the need to develop consensus-based guidelines for long-term care of these patients.
乳糜泻患者的长期随访对于监测其临床状况、饮食依从性和并发症很重要。
探讨加拿大胃肠病学家为乳糜泻患者提供长期护理的现行做法。
对加拿大所有胃肠病学家（n = 585）进行调查，了解他们的执业人口统计学、对乳糜泻诊疗指南的熟悉程度以及随访临床检查和调查情况。
向胃肠病学家邮寄了585份调查问卷，预计返回567份。共收到242份完整调查问卷（43%）。其中，237份（184名成人、51名儿童和2名混合）有包括乳糜泻患者在内的活跃执业。76%的受访者常规提供长期随访护理。随访包括年度门诊就诊（67%）、饮食审查（77%）、强化坚持无麸质饮食的必要性（90%）以及推荐加入宣传团体（65%）。78%的人进行了体格检查；大多数人开具了实验室检查，包括血清学检查（65%）。成人胃肠病学家比儿科同行更常进行常规随访肠道活检（46%对10%），但血清学检查频率较低（48%对86%）。儿科患者更有可能由多学科团队进行随访。所有儿科胃肠病学家至少熟悉一项乳糜泻诊疗指南，而15%的成人胃肠病学家不熟悉任何诊疗指南。大多数不常规提供随访的胃肠病学家期望由患者的初级医生提供护理（86%）。
参与调查的加拿大大多数胃肠病学家为乳糜泻患者提供长期随访护理。报告的不同做法强调了为这些患者的长期护理制定基于共识的指南的必要性。
