The University of Sheffield Medical School, Sheffield, UK.
Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, Sheffield, UK.
BMJ Open Gastroenterol. 2021 Jan;8(1). doi: 10.1136/bmjgast-2020-000544.
This study aimed to assess if there is secondary care medical inertia towards coeliac disease (CD).
Group (1): Time from primary care presentation to diagnostic endoscopy was quantified in 151 adult patients with a positive endomysial antibody test and compared with 92 adult patients with histologically proven inflammatory bowel disease (IBD). Group (2): Across four hospitals, duodenal biopsy reports for suspected CD were reviewed (n=1423). Group (3): Clinical complexity was compared between known CD (n=102) and IBD (n=99) patients at their respective follow-up clinic appointments. Group (4): 50 gastroenterologists were questioned about their perspective on CD and IBD.
Group (1): Suspected coeliac patients waited significantly longer for diagnostic endoscopy following referral (48.5 (28-89) days) than suspected patients with IBD (34.5 (18-70) days; p=0.003). Group (2): 1423 patients underwent diagnostic endoscopy for possible CD, with only 40.0% meeting guidelines to take four biopsies. Increased diagnosis of CD occurred if guidelines were followed (10.1% vs 4.6% p<0.0001). 12.4% of newly diagnosed CD patients had at least one non-diagnostic gastroscopy in the 5 years prior to diagnosis. Group (4): 32.0% of gastroenterologists failed to identify that CD has greater prevalence in adults than IBD. Moreover, 36.0% of gastroenterologists felt that doctors were not required for the management of CD.
Prolonged waiting times for endoscopy and inadequacies in biopsy technique were demonstrated suggesting medical inertia towards CD. However, this has to be balanced against rationalising care accordingly. A Coeliac UK National Patient Charter may standardise care across the UK.
本研究旨在评估二级医疗保健是否对乳糜泻（CD）存在惯性。
组 1：151 例抗内膜抗体阳性的成年患者从初级保健就诊到诊断性内镜的时间进行量化，并与 92 例组织学证实为炎症性肠病（IBD）的成年患者进行比较。组 2：在四家医院，对疑似 CD 的十二指肠活检报告进行了回顾（n=1423）。组 3：在各自的随访诊所就诊时，比较已知 CD（n=102）和 IBD（n=99）患者的临床复杂性。组 4：对 50 名胃肠病学家进行了关于他们对 CD 和 IBD 的看法的询问。
组 1：疑似乳糜泻患者在转诊后接受诊断性内镜检查的时间明显长于疑似 IBD 患者（48.5（28-89）天）（p=0.003）。组 2：1423 例疑似 CD 的患者进行了诊断性内镜检查，只有 40.0%的患者符合进行 4 次活检的指南。如果遵循指南，CD 的诊断率会增加（10.1%比 4.6%，p<0.0001）。新诊断的 CD 患者中有 12.4%在诊断前 5 年内至少有一次非诊断性胃镜检查。组 4：32.0%的胃肠病学家未能发现 CD 在成人中的患病率高于 IBD。此外，36.0%的胃肠病学家认为不需要医生来管理 CD。
内镜检查等待时间延长和活检技术不足表明对 CD 存在医疗惯性。然而，这必须与相应地优化护理相平衡。英国乳糜泻患者国家宪章可能会使英国的护理标准化。
