Dickey W, McConnell J B
Department of Gastroenterology, Antrim Hospital, Northern Ireland.
J Clin Gastroenterol. 1996 Jul;23(1):21-3. doi: 10.1097/00004836-199607000-00007.
We studied the hospital records of patients with celiac sprue in order to determine how frequently hospital specialists failed to make the diagnosis. Over a 7 1/2-year period, 39 patients were diagnosed, 49% within the last 18 months of the study period. Fourteen patients (39%) had been referred to the hospital a total of 30 times with features suggestive of celiac sprue, yet without being successfully diagnosed: the delay between initial referral and diagnosis was > 6 years in nine of these patients. The diagnosis was made by gastroenterologists or other internists in 38 (97%) patients. Gastroenterologists had an 85% (33 of 39) diagnostic success rate, other internists 63% (five of eight), and surgeons 7% (one of 14). None of eight referrals to other specialists led to diagnosis. While a history of diarrhea was morel likely to lead to diagnosis, it was reported by only 59% (23 of 39) of patients at the time of diagnosis and at only 46% (32 of 69) of referrals; furthermore, it did not prompt correct diagnosis in 28% (nine of 32). Anemia was the sole manifestation of celiac sprue at 17 referrals, and correct diagnosis was made in only seven (41%), all by gastroenterologists. The perceived rarity of celiac sprue reflects its underdiagnosis. Diagnosis is still delayed even in patients with classic diarrhea, and there is still a failure to appreciate the possible manifestations of sprue, including anemia without gastrointestinal symptoms. Because patients may be referred to specialists other than gastroenterologists with symptoms arising from celiac sprue, a wider knowledge of its manifestations is called for.
我们研究了乳糜泻患者的医院记录，以确定医院专科医生漏诊的频率。在7年半的时间里，共诊断出39例患者，其中49%是在研究期的最后18个月内确诊的。14例患者（39%）因具有乳糜泻的疑似特征共被转诊至该医院30次，但均未得到确诊：其中9例患者从初次转诊到确诊的延迟时间超过6年。38例（97%）患者由胃肠病学家或其他内科医生确诊。胃肠病学家的诊断成功率为85%（39例中的33例），其他内科医生为63%（8例中的5例），外科医生为7%（14例中的1例）。转诊至其他专科医生的8例患者均未得到确诊。虽然腹泻病史更有可能促使确诊，但在确诊时只有59%（39例中的23例）的患者报告有腹泻，在转诊时只有46%（69例中的32例）；此外，在有腹泻症状的患者中，仍有28%（32例中的9例）未得到正确诊断。在17次转诊中，贫血是乳糜泻的唯一表现，只有7例（41%）得到了正确诊断，且均由胃肠病学家确诊。乳糜泻被认为罕见反映了其诊断不足的情况。即使是有典型腹泻症状的患者，诊断仍会延迟，而且人们仍然没有认识到乳糜泻可能的表现，包括无胃肠道症状的贫血。由于乳糜泻引起症状的患者可能会被转诊至胃肠病学家以外的专科医生处，因此需要更广泛地了解其临床表现。
