School of Medicine, FinnMedi3, University of Tampere, FIN-33014, Tampere, Finland.
BMC Gastroenterol. 2012 Sep 27;12:136. doi: 10.1186/1471-230X-12-136.
Approximately 1% of the population suffer from coeliac disease. However, the disease is heavily underdiagnosed. Unexplained symptoms may lead to incremented medical consultations and productivity losses. The aim here was to estimate the possible concealed burden of untreated coeliac disease and the effects of a gluten-free diet.
A nationwide cohort of 700 newly detected adult coeliac patients were prospectively evaluated. Health care service use and sickness absence from work during the year before diagnosis were compared with those in the general population; the data obtained from an earlier study. Additionally, the effect of one year on dietary treatment on the aforementioned parameters and on consumption of pharmaceutical agents was assessed.
Untreated coeliac patients used primary health care services more frequently than the general population. On a gluten-free diet, visits to primary care decreased significantly from a mean 3.6 to 2.3. The consumption of medicines for dyspepsia (from 3.7 to 2.4 pills/month) and painkillers (6.8-5.5 pills/month) and the number of antibiotic courses (0.6-0.5 prescriptions/year) was reduced. There were no changes in hospitalizations, outpatient visits to secondary and tertiary care, use of other medical services, or sickness absence, but the consumption of nutritional supplements increased on treatment.
Coeliac disease was associated with excessive health care service use and consumption of drugs before diagnosis. Dietary treatment resulted in a diminished burden to the health care system and lower use of on-demand medicines and antibiotic treatment. The results support an augmented diagnostic approach to reduce underdiagnosis of coeliac disease.
ClinicalTrials.gov NCT01145287.
大约有 1%的人口患有乳糜泻。然而，这种疾病的误诊率很高。不明原因的症状可能会导致增加医疗咨询和生产力损失。本研究旨在估计未经治疗的乳糜泻可能带来的隐性负担，以及无麸质饮食的影响。
前瞻性评估了 700 名新确诊的成年乳糜泻患者的全国性队列。将诊断前一年的医疗保健服务使用情况和因病缺勤情况与一般人群（来自早期研究的数据）进行比较。此外，还评估了接受一年饮食治疗对上述参数以及药物使用的影响。
未经治疗的乳糜泻患者比一般人群更频繁地使用初级保健服务。接受无麸质饮食后，对初级保健的就诊次数从平均 3.6 次显著减少到 2.3 次。用于消化不良（从 3.7 片/月到 2.4 片/月）和止痛药（6.8-5.5 片/月）的药物以及抗生素疗程（0.6-0.5 份/年）的消耗减少。住院、二级和三级保健的门诊就诊、其他医疗服务的使用或病假均无变化，但治疗后营养补充剂的使用增加。
在诊断前，乳糜泻与过度的医疗服务使用和药物消耗有关。饮食治疗可减轻医疗保健系统的负担，并减少按需使用药物和抗生素治疗的次数。结果支持增加诊断方法以减少乳糜泻的漏诊。
ClinicalTrials.gov NCT01145287。
