We studied the hospital records of patients with celiac sprue in order to determine how frequently hospital specialists failed to make the diagnosis.
Over a 7 1/2-year period, 39 patients were diagnosed, 49% within the last 18 months of the study period.
Fourteen patients (39%) had been referred to the hospital a total of 30 times with features suggestive of celiac sprue, yet without being successfully diagnosed : the delay between initial referral and diagnosis was>6 years in nine of these patients.
The diagnosis was made by gastroenterologists or other internists in 38 (97%) patients.
Gastroenterologists had an 85% (33 of 39) diagnostic success rate, other internists 63% (five of eight), and surgeons 7% (one of 14).
None of eight referrals to other specialists led to diagnosis.
While a history of diarrhea was more likely to lead to diagnosis, it was reported by only 59% (23 of 39) of patients at the time of diagnosis and at only 46% (32 of 69) of referrals ; furthermore, it did not prompt correct diagnosis in 28% (nine of 32).
Anemia was the sole manifestation of celiac sprue at 17 referrals, and correct diagnosis was made in only seven (41%), all by gastroenterologists.
The perceived rarity of celiac sprue reflects its underdiagnosis.
Diagnosis is still delayed even in patients with classic diarrhea, and there is still a failure to appreciate the possible manifestations of sprue, including anemia without gastrointestinal symptoms. (...)
Mots-clés Pascal : Coeliaque maladie, Sprue, Diagnostic, Intervalle temps, Retard, Etude statistique, Homme, Irlande, Europe, Appareil digestif pathologie, Intestin pathologie, Malabsorption intestinale, Immunopathologie
Mots-clés Pascal anglais : Coeliac disease, Sprue, Diagnosis, Time interval, Delay, Statistical study, Human, Ireland, Europe, Digestive diseases, Intestinal disease, Intestinal malabsorption, Immunopathology
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0357291
Code Inist : 002B13B03. Création : 10/04/1997.