Chandler Kim, Robins Gerry
Associate Specialist, Department of Gastroenterology, York Teaching Hospital NHS Foundation Trust, York, UK.
Consultant Gastroenterologist, Department of Gastroenterology, York Teaching Hospital NHS Foundation Trust, York, UK
BJGP Open. 2019 Jul 23;3(2). doi: 10.3399/bjgpopen19X101648. Print 2019 Jul.
Over 75% of patients (approximately half a million) with coeliac disease in the UK have not been formally diagnosed.
To determine if case-finding of coeliac disease is better than random testing in primary care.
DESIGN & SETTING: A pragmatic study looked at all referrals across a 12-month period (December 2013-November 2014) for coeliac serology testing and the indications for testing across 38 GP practices in a well-defined geographical area in North Yorkshire. There was further follow-up for an additional 12 months to determine conversion of positive serology to duodenal biopsy.
All serology samples sent into York Hospital biochemistry department during the study period were analysed for the indication for testing. Positive results were cross-referenced for duodenal biopsies over the following 12 months on the York Hospital pathology database.
Case-finding of coeliac patients in primary care is no better than random testing of the population. Only 71% of patients with positive serology went on to have a duodenal biopsy in the following 12 months.
More education of the population and of primary care physicians is needed around the indications for checking for coeliac disease. It may be that primary care is not the best place to case-find patients with coeliac disease.
在英国，超过75%的乳糜泻患者（约50万）尚未得到正式诊断。
确定在初级保健中，乳糜泻病例发现是否优于随机检测。
一项实用性研究观察了在12个月期间（2013年12月至2014年11月），北约克郡一个明确地理区域内38家全科医生诊所转诊进行乳糜泻血清学检测的所有病例以及检测指征。进一步随访12个月，以确定血清学阳性转为十二指肠活检的情况。
对研究期间送至约克医院生化科的所有血清学样本进行检测指征分析。在接下来的12个月里，在约克医院病理数据库中对阳性结果与十二指肠活检进行交叉对照。
初级保健中乳糜泻患者的病例发现并不优于对人群的随机检测。在接下来的12个月里，只有71%血清学阳性的患者进行了十二指肠活检。
需要对公众和初级保健医生进行更多关于乳糜泻检查指征的教育。可能初级保健并非发现乳糜泻患者的最佳场所。
