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At the heart of general practice since 1960

GPs alerted over missed coeliac cases

By Daniel Cressey

Children are suffering growth retardation because coeliac disease is hugely underdiagnosed, researchers warn.

GPs are diagnosing only 10 per cent of cases, with the other 90 per cent slipping through the net, their study found.

The researchers urged GPs to be more ready to investigate possible cases with blood tests, after finding children with the condition suffered significant growth problems.

Professor Bhupinder Sandhu, head of the gastroenterology and nutrition unit at the Royal Hospital for Sick Children in Bristol, said: 'Ninety per cent of children with possible coeliac disease may be being missed. Screening data also recorded that children with positive screening tests were lagging behind in growth by nine months.'

The researchers screened 5,470 children using tissue transglutaminase and IgA endomysial antibodies and found 54 proved positive for coeliac disease, suggesting a prevalence of around 1 per cent.

But in a parallel population in Avon, only 12 children had received a diagnosis of coeliac disease, at a prevalence of less than 0.1 per cent.

A second study, like the first presented at this week's British Society of Gastroenterology annual meeting in Birmingham, found severe delays in diagnosis of coeliac disease, with more than one in eight patients waiting more than two years.

The researchers produced a set of recommendations for ensuring rapid diagnosis (see box).

Study leader Dr Peter Gillett, consultant paediatric gastroenterologist at the Royal Hospital for Sick Children in Edinburgh, said: 'The study shows we're getting better but there's still scope for improvement.

'Coeliac disease is a condition that can easily be diagnosed or excluded in general practice by either doing the blood test at the GP surgery or if the facilities exist sending a kid up to the hospital to have the blood taken.'

Dr Sohail Butt, who screens for coeliac disease in his practice in Ashford, Middlesex, said: 'What's interesting is it shows these people were lagging behind on growth. This seems to suggest there is some benefit in being picked up earlier.'

He added: 'GPs should be more ready to assess people for coeliac disease. It is more common than most people think.'

Advice for avoiding delays in diagnosis

· Consider coeliac disease when investigating growth delay and iron deficiency anaemia

· Measure IgA in all suspected cases

· Arrange biopsy for all children with positive serology

· Repeat without delay if initial biopsy is inadequate

· Ensure good communication with patients

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