Dataset Information

A case-control study of presentations in general practice before diagnosis of coeliac disease.

ABSTRACT:

Background

Delay in the diagnosis of coeliac disease prolongs morbidity and may increase mortality. Little is known about presentations in general practice that may predict a subsequent diagnosis of coeliac disease.

Aim

To examine presentations in general practice during the 5 years prior to diagnosis of coeliac disease.

Design of study

A case-control study with each biopsy-proven coeliac disease case matched by age, sex, and general practice to an average of two controls.

Setting

Thirty-seven general practices in south-east Wales.

Method

Cases were identified via a secondary care clinic and controls recruited from the general practices of cases. General practice clinical records of both cases and controls were analysed to determine frequency of consultations, presenting symptoms, diagnoses, referrals, and investigations during the 5 years prior to diagnosis.

Results

Cases (n = 68) had an increased number of consultations compared with controls (n = 160) during the 5 years prior to diagnosis (mean difference five consultations, P = 0.001). Three clinical features were independently associated with subsequent diagnosis of coeliac disease: depression and/or anxiety (odds ratio [OR] = 2.5, 95% confidence interval [CI] = 1.1 to 5.7, P = 0.031); diarrhoea (OR = 4.5, 95% CI = 2.0 to 10.0, P <0.001); and anaemia (OR = 26.3, 95% CI = 5.7 to 120.6, P <0.001). Both diarrhoea and anaemia remained associated even when data for the year prior to diagnosis was excluded from the analysis.

Conclusion

[corrected] GPs should consider testing for coeliac disease when patients present often, especially with diarrhoea and/or who are discovered to be anaemic. Further research is required to clarify the role of depression and/or anxiety in the diagnosis of coeliac disease.

SUBMITTER: Cannings-John R

PROVIDER: S-EPMC2099669 | biostudies-literature | 2007 Aug

REPOSITORIES: biostudies-literature

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Publications

A case-control study of presentations in general practice before diagnosis of coeliac disease.

Cannings-John Rebecca R Butler Christopher C CC Prout Hayley H Owen Diane D Williams Della D Hood Kerenza K Crimmins Rosemary R Swift Gillian G

The British journal of general practice : the journal of the Royal College of General Practitioners 20070801 541

<h4>Background</h4>Delay in the diagnosis of coeliac disease prolongs morbidity and may increase mortality. Little is known about presentations in general practice that may predict a subsequent diagnosis of coeliac disease.<h4>Aim</h4>To examine presentations in general practice during the 5 years prior to diagnosis of coeliac disease.<h4>Design of study</h4>A case-control study with each biopsy-proven coeliac disease case matched by age, sex, and general practice to an average of two controls.< ...[more]

PMID: 17688758

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Project description:INTRODUCTION:Haemorheological and haemostatic changes predispose to the development of arterial and venous thrombotic events; however, limited information is available on the status of these changes in coeliac disease (CeD) and inflammatory bowel disease (IBD). In this study, we aim to describe the haemorheological and haemostatic profiles of CeD and IBD patients in a Hungarian cohort of patients to investigate whether any alterations contribute to elevated thrombotic risk. METHODS AND ANALYSIS:This is a case-control study involving newly diagnosed and followed CeD and IBD patients with age-matched and sex-matched non-CeD, non-IBD subjects with an allocation ratio of 1:1:1.After informed consent is obtained, a detailed medical history will be collected, including venous and arterial thrombotic risk factors and medications. Symptoms in CeD patients will be assessed with the Gastrointestinal Symptoms Rating Scale, and disease activity in IBD patients will be determined by disease-specific scores. Dietary adherence will be assessed among CeD patients with a thorough interview together with a measurement of self-reported adherence, dietary knowledge and urine analysis (detection of gluten immunogenic peptides). In addition to routine laboratory parameters, haemorheological (ie, erythrocyte deformability and aggregation, viscosity of whole blood and plasma) and haemostatic parameters (eg, protein C, protein S and antithrombin) with immunological indicators (ie, coeliac-specific serology and antiphospholipid antibodies) will be measured from venous blood for every participant.Primary and secondary outcomes will be haemorheological and haemostatic parameters, respectively. Univariate and multivariate statistics will be used to compare CeD and IBD patients to control subjects. Subgroup analysis will be performed by disease type in IBD, (Crohn's disease and ulcerose colitis), dietary adherence in CeD, and disease activity in IBD and CeD. ETHICS AND DISSEMINATION:The study was approved by the Regional and Local Research Ethics Committee, University of Pécs (Ref. No. 6917). Findings will be disseminated at research conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER:ISRCTN49677481.

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Dataset Information

A case-control study of presentations in general practice before diagnosis of coeliac disease.

Background

Aim

Design of study

Setting

Method

Results

Conclusion

Publications

A case-control study of presentations in general practice before diagnosis of coeliac disease.

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