Determining whether coeliac disease case-finding in primary care is better than random testing: a retrospective study

BACKGROUND: Over 75% of patients (approximately half a million) with coeliac disease in the UK have not been formally diagnosed. AIM: To determine if case-finding of coeliac disease is better than random testing in primary care. DESIGN & SETTING: A pragmatic study looked at all referrals across a 12-month period (December 2013–November 2014) for coeliac serology testing and the indications for testing across 38 GP practices in a well-defined geographical area in North Yorkshire. There was further follow-up for an additional 12 months to determine conversion of positive serology to duodenal biopsy. METHOD: All serology samples sent into York Hospital biochemistry department during the study period were analysed for the indication for testing. Positive results were cross-referenced for duodenal biopsies over the following 12 months on the York Hospital pathology database. RESULTS: Case-finding of coeliac patients in primary care is no better than random testing of the population. Only 71% of patients with positive serology went on to have a duodenal biopsy in the following 12 months. CONCLUSION: More education of the population and of primary care physicians is needed around the indications for checking for coeliac disease. It may be that primary care is not the best place to case-find patients with coeliac disease.