Dickey W, McMillan S A, Hughes D F
Dept. of Gastroenterology, Altnagelvin Hospital, Londonderry, Northern Ireland.
Scand J Gastroenterol. 1998 May;33(5):491-3. doi: 10.1080/00365529850172043.
Coeliac disease is common yet often undiagnosed because symptoms may be trivial, non-specific, or non-gastrointestinal, or because of lack of clinician awareness. Serum IgA-class endomysial antibodies (EmA) have high specificity for coeliac disease and may facilitate case-finding by clinicians other than gastroenterologists. We assessed the appropriateness and diagnostic yield of of requests for EmA by primary care general practitioners in a defined geographic area of Northern Ireland.
We identified patients who had EmA examination requests by their general practitioners during 1994-1996. Individual patient questionnaires were posted to the general practitioners concerned, seeking information on indications for testing, management after the result, and final diagnosis. We compared new patient diagnosis rates in two catchment areas, one served by a large district general hospital with, and the other by smaller hospitals without, a medical gastroenterology facility.
A total of 239 patients had coeliac profile testing by 69 of 177 general practitioners in the area. Data were available for 181 patients not previously known to have coeliac disease, of whom 20 (11%) had EmA. All EmA-positive patients were referred to hospital, where 19 underwent small-bowel biopsy, which confirmed coeliac disease in all 19. Only 7 (35%) of the 20 had diarrhoea, and there was no significant difference in EmA prevalence among patients tested with and without diarrhoea. Although the mean number of new patients (per 100,000 population annually) diagnosed by biopsy was 11 at the large hospital compared with 5 elsewhere, the numbers identified by EmA in general practice for the 2 catchment areas were similar (2 and 3, respectively).
General practitioners have an important role in the identification of patients with coeliac disease, particularly where there is no local medical gastroenterology facility, and this is facilitated by EmA testing.
乳糜泻很常见，但常未被诊断出来，原因可能是症状轻微、不具特异性或非胃肠道症状，也可能是临床医生缺乏认识。血清IgA类肌内膜抗体（EmA）对乳糜泻具有高度特异性，可能有助于非胃肠病科临床医生发现病例。我们评估了北爱尔兰一个特定地理区域内基层医疗全科医生申请EmA检测的适宜性和诊断率。
我们确定了1994 - 1996年期间其全科医生申请进行EmA检测的患者。向相关全科医生发送了个体患者问卷，以获取检测指征、结果后的处理及最终诊断等信息。我们比较了两个集水区的新患者诊断率，一个由设有胃肠病科的大型地区综合医院服务，另一个由未设胃肠病科的较小医院服务。
该地区177名全科医生中的69名对总共239名患者进行了乳糜泻相关检测。有181名此前未知患有乳糜泻的患者的数据可用，其中20名（11%）有EmA检测结果。所有EmA阳性患者均被转诊至医院，其中19名接受了小肠活检，所有19名患者均被确诊为乳糜泻。20名患者中只有7名（35%）有腹泻症状，有腹泻和无腹泻的检测患者中EmA患病率无显著差异。虽然大型医院经活检诊断的新患者平均数量（每年每10万人口）为11名，而其他地方为5名，但两个集水区通过全科医生EmA检测发现的患者数量相似（分别为2名和3名）。
全科医生在识别乳糜泻患者方面发挥着重要作用，尤其是在当地没有胃肠病科的情况下，而EmA检测有助于这一过程。
