Article Text

Do gastroenterologists have medical inertia towards coeliac disease? A UK multicentre secondary care study
  1. Matthew A Taylor1,
  2. Rebecca J Blanshard2,3,
  3. Gregory Naylor4,
  4. Hugo A Penny2,
  5. Peter D Mooney5,6,
  6. David S Sanders1,2
  1. 1The University of Sheffield Medical School, Sheffield, UK
  2. 2Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, Sheffield, UK
  3. 3The University of Sheffield, Sheffield, Sheffield, UK
  4. 4Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, Derbyshire, UK
  5. 5Department of Gastroenterology, Northern General Hospital, Sheffield, Sheffield, UK
  6. 6Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK
  1. Correspondence to Professor David S Sanders; david.sanders1{at}nhs.net

Abstract

Objective This study aimed to assess if there is secondary care medical inertia towards coeliac disease (CD).

Design Group (1): Time from primary care presentation to diagnostic endoscopy was quantified in 151 adult patients with a positive endomysial antibody test and compared with 92 adult patients with histologically proven inflammatory bowel disease (IBD). Group (2): Across four hospitals, duodenal biopsy reports for suspected CD were reviewed (n=1423). Group (3): Clinical complexity was compared between known CD (n=102) and IBD (n=99) patients at their respective follow-up clinic appointments. Group (4): 50 gastroenterologists were questioned about their perspective on CD and IBD.

Results Group (1): Suspected coeliac patients waited significantly longer for diagnostic endoscopy following referral (48.5 (28–89) days) than suspected patients with IBD (34.5 (18–70) days; p=0.003). Group (2): 1423 patients underwent diagnostic endoscopy for possible CD, with only 40.0% meeting guidelines to take four biopsies. Increased diagnosis of CD occurred if guidelines were followed (10.1% vs 4.6% p<0.0001). 12.4% of newly diagnosed CD patients had at least one non-diagnostic gastroscopy in the 5 years prior to diagnosis. Group (4): 32.0% of gastroenterologists failed to identify that CD has greater prevalence in adults than IBD. Moreover, 36.0% of gastroenterologists felt that doctors were not required for the management of CD.

Conclusion Prolonged waiting times for endoscopy and inadequacies in biopsy technique were demonstrated suggesting medical inertia towards CD. However, this has to be balanced against rationalising care accordingly. A Coeliac UK National Patient Charter may standardise care across the UK.

  • coeliac disease
  • endoscopic procedures
  • gluten
  • inflammatory bowel disease
  • antiendomysial antibodies

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Data available on reasonable request from the corresponding author.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Data available on reasonable request from the corresponding author.

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Footnotes

  • Contributors DSS designed the study. RJB, GN, MAT, HAP and PDM recruited patient numbers and contributed to clinical data collection. All authors analysed the data. MAT, RJB and DSS drafted the manuscript. The final manuscript was revised and approved by all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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