ObjectiveThis study aimed to assess if there is secondary care medical inertia towards coeliac disease (CD).DesignGroup (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.ResultsGroup (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.ConclusionProlonged 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.

No abstract

No abstract

Background - Adult coeliac disease (CD) has delays in diagnosis but the reasons for this have not been explored. Methods - Group 1) Time from primary care presentation to diagnostic endoscopy was prospectively quantified in 151 adult patients with a positive endomysial antibody test and compared with the diagnostic pathway of 92 adult patients with suspected inflammatory bowel disease (IBD). Group 2) Across 4 hospitals over a 3-month period, duodenal biopsy reports for suspected CD were reviewed (n=1423). Group 3) 50 gastroenterologists completed questionnaires concerning their viewpoints on CD. Results - Group 1) Suspected coeliac patients waited significantly longer for diagnostic endoscopy following referral (48.5 [28-89] days) than suspected IBD patients (34.5 [18-70] days; p=0.003). Group 2) Of the 1423 patients that underwent diagnostic endoscopy for possible CD, 40.0% met the guidelines to take at least 4 biopsies. Diagnosis of CD was more likely if these guidelines were followed (10.1% vs 4.6% p<0.0001). 12.4% of newly diagnosed CD patients had at least 1 non-diagnostic gastroscopy in the 5 years prior to diagnosis. Group 3) 32.0% (16) of gastroenterologists failed to identify that CD has greater prevalence in adults than IBD. Moreover, 36.0% (18) of gastroenterologists felt that doctors were not required for the management of CD. Conclusion - Prolonged waiting times for endoscopy and inadequacies in biopsy technique suggest clinical inertia towards CD. This is exemplified by the nihilistic approach to the condition demonstrated in our qualitative data. This is the first study to demonstrate clinical inertia towards CD.