To provide evidence of underdiagnosis of coeliac disease and to describe the main presenting symptoms of coeliac disease in primary care.
Case finding in a primary care setting by testing for coeliac disease by using the endomysial antibody test.
Nine surgeries in and around a market town in central England, serving a population of 70000.
First 1000 patients screened from October 1996 to October 1997.
Determination of endomysial antibody titre of patients fulfilling the study criteria, followed by small intestine biopsy of those with positive results.
The 30 patients (out of 1000 samples) with positive results on the endomysial antibody test all had histological confirmation on small intestine biopsy. The commonest mode of presentation (15/30) was anaemia of varying severity. Most patients (25/30) presented with non-gastrointestinal symptoms. Specificity of the endomysial antibody test was 30/30.
Underdiagnosis and misdiagnosis of coeliac disease are common in general practice and often result in protracted and unnecessary morbidity. Serological screening in primary care will uncover a large proportion of patients with this condition and should be made widely available and publicised. Coeliac disease should be considered in patients who have anaemia or are tired all the time, especially when there is a family history of the disease.
- General practitioners currently see many people with undiagnosed coeliac disease
- The most likely presentation is a combination of microcytic anaemia, past or present, a family history of the disease, and feeling tired all the time
- Estimations of endomysial antibody and IgA are reliable diagnostic tools
- The prevalence of coeliac disease in Britain is higher than the accepted figure of 1:1000 population
- Increased awareness of the extra intestinal manifestations of coeliac disease, coupled with a low threshold for serological testing, will uncover a large portion of undiagnosed coeliac disease