PWE-043 Clinical inertia in coeliac disease

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Abstract

Introduction

Clinicians’ knowledge and practice may directly affect patients’ diagnostic pathway. An Endomysial antibody (EMA) has a>90% positive predictive value for coeliac disease. Furthermore NICE have recommended that patients with suspected coeliac disease should have an endoscopy and biopsy within 6 weeks. This should serve to reduce the temptation by the patient to start a Gluten free diet (GFD). We aimed to determine GI Consultant practice by assessing their ‘grading’ for patients referred from primary care with a positive EMA. In addition, we sought to determine Gastroenterologists’ views about coeliac disease.

Method

Data regarding time to diagnostic endoscopy was collected from adult patients who had a positive EMA test in primary care from 2 centres (n=151). As a comparator cohort, we collected data regarding the time from symptom presentation in primary care to index endoscopy in adults referred with suspected IBD (n=92). In addition, an unselected cohort of Gastroenterology consultants and specialist registrars (n=50) completed a questionnaire regarding coeliac disease.

Results

The median time from positive EMA identified in primary care to referral for diagnostic endoscopy was 23 (12-35) days; the time from referral to endoscopy was 55 (26-90) days. Overall, coeliac patients waited significantly longer from referral to endoscopy than patients who were diagnosed with IBD (34.5 [18-70] days; p=0.006). Overall time from EMA positive blood test to endoscopy was 78 (58-120) days.

Results

32% (16) of Gastroenterologists failed to identify that coeliac disease was more prevalent in the adult population than IBD. 16% (8) of respondents felt that a diagnosis of coeliac disease does not significantly impact patient quality of life. 36% (18) felt that doctors were not required for the adequate management of coeliac disease.

Conclusion

There are delays in diagnosis for patients with coeliac disease. This may impact treatment intensification and thus patient related outcomes. Our data suggest that provider-related beliefs may contribute to clinical inertia in this condition. We advocate enhancing both undergraduate and postgraduate training about coeliac disease to help reduce this effect.

Disclosure of Interest

None Declared

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