Barnea Liron, Mozer-Glassberg Yael, Hojsak Iva, Hartman Corina, Shamir Raanan
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Digestion. 2014;90(4):248-53. doi: 10.1159/000368395. Epub 2014 Dec 19.
Follow-up of celiac disease (CD) patients is recommended for gluten-free diet (GFD) adherence monitoring and complication detection. We recently showed that 35% of children with CD were lost to follow-up (LTFU). We aimed to characterize LTFU population, and thus identify compliance barriers to GFD and follow-up.
50 LTFU patients were investigated using a telephone questionnaire, regarding frequency of follow-up, serology testing, and adherence to GFD (using the validated Biagi score). Fifty two regular follow-up patients served as controls.
LTFU patients had poor adherence to GFD (average Biagi score of 2.0 ± 1.4) compared to controls (3.0 ± 1.0, p < 0.001). Only 22% of LTFU performed periodic celiac serology testing compared to 82% of controls (p < 0.001). LTFU had higher prevalence of positive celiac serology tests (50% compared to 25% of controls, p = 0.01). Fewer LTFU were National Celiac Association members (24%) compared with controls (44%, p = 0.05). Regression analysis showed positive relationships between LTFU and poor adherence to GFD (R(2) = 0.26737, p = 0.001), older age at diagnosis (R(2) = 0.30046, p = 0.03), and non-membership in a celiac association (R(2) = 0.18591, p = 0.0001).
LTFU is associated with non-adherence to GFD and positive serology. Risk factors for LFTU should be identified and addressed in order to improve patient care.
建议对乳糜泻（CD）患者进行随访，以监测无麸质饮食（GFD）的依从性并检测并发症。我们最近发现35%的CD患儿失访（LTFU）。我们旨在对失访人群进行特征分析，从而确定GFD依从性和随访的障碍因素。
采用电话问卷对50例失访患者进行调查，内容包括随访频率、血清学检测以及GFD依从性（使用经过验证的Biagi评分）。52例定期随访患者作为对照。
与对照组相比，失访患者对GFD的依从性较差（平均Biagi评分为2.0±1.4）（对照组为3.0±1.0，p<0.001）。只有22%的失访患者进行定期乳糜泻血清学检测，而对照组为82%（p<0.001）。失访患者乳糜泻血清学检测阳性的患病率更高（50%，而对照组为25%，p=0.01）。失访患者中加入全国乳糜泻协会的人数较少（24%），而对照组为44%（p=0.05）。回归分析显示，失访与GFD依从性差（R²=0.26737，p=0.001）、诊断时年龄较大（R²=0.30046，p=0.03）以及未加入乳糜泻协会（R²=0.18591，p=0.0001）之间存在正相关关系。
失访与GFD不依从和血清学阳性有关。应识别并解决失访的危险因素，以改善患者护理。
