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Low adherence to biopsy guidelines affects celiac disease diagnosis in the United States
Date:7/7/2011

NEW YORK, NY (July 6, 2011) - A new study has found that most patients undergoing biopsy of the small intestine do not have the recommended number of samples to diagnose celiac disease. The study, published in the July 2011 issue of Gastrointestinal Endoscopy, analyzed a national database of biopsy specimens maintained by Caris Life Sciences (Irving, TX). More than 100,000 patients had a biopsy of the small intestine, but only 35 percent of them had at least four samples taken, the number recommended by professional guidelines.

Celiac disease is common, affecting approximately 1 percent of the population in the United States. However, the vast majority of patients with celiac disease in the United States have not been diagnosed. Many of these patients seek health care for symptoms including diarrhea, weight loss, or fatigue due to anemia. The diagnosis of celiac disease is made by biopsy of the small intestine, but factors related to the performance of biopsy may contribute to the under-diagnosis of celiac disease in the United States.

"Celiac disease can affect the small intestine in a patchy distribution, and so just one or two biopsy samples could potentially miss the evidence of the disease," said lead author Benjamin Lebwohl, MD, MS, a gastroenterologist at the Celiac Disease Center at Columbia University Medical Center, in New York. Dr. Lebwohl and co-authors aimed to measure the practice of small intestinal biopsy in the United States. The Caris pathology database consists of specimens submitted by gastroenterologists from 43 states as well as Puerto Rico and the District of Columbia. The team also compared the diagnosis rate among patients who had at least four specimens submitted, in accordance with guidelines.

The investigators identified 132,352 individuals who underwent biopsy between 2006 and 2009, for a variety of medical indications, including diarrhea, abdominal pain, esophageal reflux, and anemia. Only
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Contact: Cynthai Beckman
cb2280@columbia.edu
646-812-1212
Columbia University Medical Center
Source:Eurekalert

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