Internal Medicine Department, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.
Penn State College of Medicine, Hershey, Pennsylvania, USA.
Dig Dis. 2023;41(2):343-352. doi: 10.1159/000525398. Epub 2022 Jun 15.
Strict adherence to a gluten-free diet is the only known effective treatment for celiac disease currently. Multiple organizations recommend follow-up with a dietitian and guideline-directed management after diagnosis. Few studies have evaluated follow-up post diagnosis. However, these do not include a systematic process for monitoring dietary referral among celiac disease patients. We sought to evaluate and compare the frequency of early dietary referral and guideline-directed preventive care and management for celiac disease patients managed by gastroenterologists and primary care providers.
A retrospective chart review of celiac disease patients receiving care at a single tertiary care facility. Our primary outcome was to compare the frequency of dietary intervention between gastroenterologists and primary care providers in an outpatient setting after initial diagnosis. Multivariate analysis was performed to determine associated factors for referral for dietary intervention and recommended follow-up lab work.
261 patients were included in the study, 81.6% were followed by gastroenterologist and only 51% were seen by a dietitian. Patients following up with gastroenterologists had higher odds of referral for dietary intervention on multivariate analysis (OR 3.29, p value <0.003). Only 16% of all patients completed appropriate guideline-directed follow-up care.
Dietary intervention and follow-up of preventive care lab work were low in celiac disease patients. There is an opportunity for further education of both primary care providers and gastroenterologists on the importance of early dietary referral and appropriate medical management at follow-up.
目前，严格遵循无麸质饮食是治疗乳糜泻的唯一有效方法。多个组织建议在诊断后由营养师随访和进行指南指导的管理。很少有研究评估诊断后的随访情况。然而，这些研究并没有包括对乳糜泻患者的饮食推荐进行监测的系统流程。我们旨在评估和比较由胃肠病学家和初级保健提供者管理的乳糜泻患者的早期饮食推荐和指南指导的预防性护理和管理的频率。
对在一家三级保健机构接受治疗的乳糜泻患者进行回顾性图表审查。我们的主要结果是比较在初始诊断后，胃肠病学家和初级保健提供者在门诊环境下进行饮食干预的频率。进行多变量分析以确定与饮食干预推荐和建议的随访实验室检查相关的因素。
本研究共纳入 261 例患者，81.6%由胃肠病学家随访，仅有 51%的患者接受营养师的随访。多变量分析显示，接受胃肠病学家随访的患者进行饮食干预的可能性更高（OR 3.29，p 值<0.003）。仅有 16%的患者完成了适当的指南指导的随访护理。
乳糜泻患者的饮食干预和预防保健实验室检查的随访情况较差。需要对初级保健提供者和胃肠病学家进行进一步教育，强调早期饮食推荐和随访时适当的医疗管理的重要性。
