Barriers impeding serologic screening for celiac disease in clinically high-prevalence populations

BMC Gastroenterology

Research Article

Michael C Donohue¹  Erika M Barbero²  Martin F Kagnoff³  Shawna L McNally⁴ 

[1] Department of Family and Preventive Medicine, Division of Biostatistics and Bioinformatics, University of California San Diego, La Jolla, CA, USA;Department of Medicine, Division of Gastroenterology, University of California San Diego, 9500 Gilman Drive, 92093 MC 0623D, La Jolla, CA, USA;Department of Medicine, Division of Gastroenterology, University of California San Diego, 9500 Gilman Drive, 92093 MC 0623D, La Jolla, CA, USA;Department of Pediatrics, Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA;Department of Medicine, Division of Gastroenterology, University of California San Diego, 9500 Gilman Drive, 92093 MC 0623D, La Jolla, CA, USA;Nutrition Research Consultant, Harvard Center for Population and Development Studies, Providence, RI, USA;

关键词: Celiac disease;    Serologic screening;    Barriers to screening;   

DOI  :  10.1186/1471-230X-14-42

 received in 2013-11-24, accepted in 2014-02-28,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundCeliac disease is present in ~1% of the general population in the United States and Europe. Despite the availability of inexpensive serologic screening tests, ~85% of individuals with celiac disease remain undiagnosed and there is an average delay in diagnosis of symptomatic individuals with celiac disease that ranges from ~5.8-11 years. This delay is often attributed to the use of a case-based approach for detection rather than general population screening for celiac disease, and deficiencies at the level of health care professionals. This study aimed to assess if patient-centered barriers have a role in impeding serologic screening for celiac disease in individuals from populations that are clinically at an increased risk for celiac disease.Methods119 adults meeting study inclusion criteria for being at a higher risk for celiac disease were recruited from the general population. Participants completed a survey/questionnaire at the William K. Warren Medical Research Center for Celiac Disease that addressed demographic information, celiac disease related symptoms (gastrointestinal and extraintestinal), family history, co-morbid diseases and conditions associated with celiac disease, and patient-centered barriers to screening for celiac disease. All participants underwent serologic screening for celiac disease using the IgA tissue transglutaminase antibody (IgA tTG) and, if positive, testing for IgA anti-endomysial antibody (IgA EMA) as a confirmatory test.ResultsTwo barriers to serologic testing were significant across the participant pool. These were participants not knowing they were at risk for celiac disease before learning of the study, and participants not knowing where to get tested for celiac disease. Among participants with incomes less than $25,000/year and those less than the median age, not having a doctor to order the test was a significant barrier, and this strongly correlated with not having health insurance. Symptoms and co-morbid conditions were similar among those whose IgA tTG were negative and those who tested positive.ConclusionThere are significant patient-centered barriers that impede serologic screening and contribute to the delayed detection and diagnosis of celiac disease. These barriers may be lessened by greater education of the public and health care professionals about celiac disease symptoms, risk factors, and serologic testing.

【 授权许可】

Unknown   
© Barbero et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.