Spencer Marisa, Lenhart Adrienne, Baker Jason, Dickens Joseph, Weissman Arlene, Read Andrew J, Saini Seema, Saini Sameer D
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America.
Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan, United States of America.
PLoS One. 2017 Sep 20;12(9):e0184754. doi: 10.1371/journal.pone.0184754. eCollection 2017.
Iron deficiency anemia (IDA) is a common extra-intestinal manifestation of celiac disease (CD). Little is known about the frequency with which primary care physicians (PCPs) test for CD in patients with IDA. We aimed to describe how PCPs approach testing for CD in asymptomatic patients with IDA.
We electronically distributed a survey to PCPs who are members of the American College of Physicians. Respondents were asked whether they would test for CD (serologic testing, refer for esophagogastroduodenoscopy [EGD], or refer to GI) in hypothetical patients with new IDA, including: (1) a young Caucasian man, (2) a premenopausal Caucasian woman, (3) an elderly Caucasian man, and (4) a young African American man. These scenarios were chosen to assess for differences in testing for CD based on age, gender, and race. Multivariable logistic regression was used to identify independent predictors of testing.
Testing for CD varied significantly according to patient characteristics, with young Caucasian men being the most frequently tested (61% of respondents reporting they would perform serologic testing in this subgroup (p<0.001)). Contrary to guideline recommendations, 80% of respondents reported they would definitely or probably start a patient with positive serologies for CD on a gluten free diet prior to confirmatory upper endoscopy.
PCPs are under-testing for CD in patients with IDA, regardless of age, gender, race, or post-menopausal status. The majority of PCPs surveyed reported they do not strictly adhere to established guidelines regarding a confirmatory duodenal biopsy in a patient with positive serology for CD.
缺铁性贫血（IDA）是乳糜泻（CD）常见的肠外表现。对于初级保健医生（PCP）对IDA患者进行CD检测的频率知之甚少。我们旨在描述PCP如何对无症状IDA患者进行CD检测。
我们以电子方式向美国医师协会成员中的PCP分发了一项调查。受访者被问及在假设的新发IDA患者中，他们是否会进行CD检测（血清学检测、转诊进行食管胃十二指肠镜检查[EGD]或转诊至胃肠病科），这些患者包括：（1）一名年轻的白人男性，（2）一名绝经前的白人女性，（3）一名老年白人男性，以及（4）一名年轻的非裔美国男性。选择这些场景是为了评估基于年龄、性别和种族的CD检测差异。使用多变量逻辑回归来确定检测的独立预测因素。
根据患者特征，CD检测差异显著，年轻白人男性检测频率最高（61%的受访者表示他们会在该亚组中进行血清学检测（p<0.001））。与指南建议相反，80%的受访者表示他们肯定或可能会在确诊性上消化道内镜检查之前，让CD血清学检测呈阳性的患者开始无麸质饮食。
无论年龄、性别、种族或绝经后状态如何，PCP对IDA患者的CD检测不足。大多数接受调查的PCP表示，他们没有严格遵守关于对CD血清学检测呈阳性的患者进行确诊性十二指肠活检的既定指南。
