Increased education for PCPs could aid early diagnosis of celiac disease, improve care
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CHICAGO — A large knowledge gap identified between gastroenterologists and primary care physicians in the diagnosis and management of patients with celiac disease highlights the need for further education for general practitioners.
“Both gastroenterologists and primary care physicians are responsible for the diagnosis and management of patients with celiac disease,” Niamh Harvey, BSc, a program executive at Adelphi Real World in the United Kingdom, said during a poster presentation at Digestive Disease Week. “But whether there are differences in their disease knowledge and management of celiac disease is unknown.”
To explore disease knowledge among gastroenterologists (GIs) and PCPs, Harvey and colleagues analyzed data from the Adelphi Disease Specific Program for Celiac Disease, a point-in-time survey conducted in Germany, Italy, Spain and the U.S. from July 2021 to January 2022.
Researchers collected data on treatment practices, including methods of diagnosing and monitoring celiac disease, disease severity and Marsh classification based on the degree of villus atrophy in the small intestine. Their analysis included 178 GIs and 100 PCPs.
Result showed GIs reported a higher use of biopsies and blood and imaging tests for diagnosis compared with PCPs, although both groups reported similar trends for monitoring. More PCPs reported they do not use Marsh classification compared with GIs (70% vs. 26%), while GIs were more likely than PCPs to consider villus atrophy when measuring disease progression (75% vs. 47%), severity (75% vs. 54%) and remission status (72% vs. 51%).
Researchers also reported variations in the amount of gluten deemed to be safe, with 58% of GIs stating there is no safe level compared with 35% of PCPs. Additionally, 17% of PCPs did not know whether any gluten intake is acceptable for non-symptomatic patients compared with 8% of GIs.
Of note, 60% of GIs and 50% of PCPs said that increased awareness and education for PCPs would help facilitate early diagnosis of celiac disease.
“We found significant differences between GIs and PCPs in the diagnosing and monitoring as well as recognizing disease severity and remission in celiac disease patients,” Harvey concluded. “We also observed a knowledge gap among PCPs regarding the reversibility of villous atrophy and safety of gluten intake.”
She continued, “Our studies indicate there is a need for further education of PCPs on celiac disease with the view that this could improve the consistency of care received by patients with celiac disease.”
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Harvey N, et al. Poster EP66: Physician management of celiac disease: A comparison of disease knowledge, diagnosis and patient management between gastroenterologists and primary care physicians in Germany, Italy, Spain and the United States – Findings from a real-world study. Presented at: Digestive Disease Week; May 6-9, 2023; Chicago (hybrid).
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