Navigation Links
New study finds low rates of biopsy contribute to celiac disease underdiagnosis in US

New York, NY (June 29, 2012) -- Under-performance of small bowel biopsy during endoscopy may be a major reason that celiac disease remains underdiagnosed in the United States, according to a new study published online recently in Gastrointestinal Endoscopy. Investigators at the Celiac Disease Center at Columbia University Medical Center (CUMC) found that the rate of small bowel biopsy is low in this country.

"The vast majority of people with celiac disease in the United States remain undiagnosed," said lead author Benjamin Lebwohl, MD, MS, assistant professor of clinical medicine in the Division of Digestive and Liver Diseases, and a gastroenterologist and epidemiologist at the Celiac Disease Center, CUMC. "This stands in contrast to countries in Western Europe and Scandinavia, where patients with celiac disease are much more likely to be diagnosed. Are patients with celiac disease in the United States not seeking medical attention? Actually, this study shows that some of these undiagnosed patients may be coming to see a gastroenterologist and still are not getting the biopsy they need for a diagnosis."

Dr. Lebwohl and colleagues analyzed the Clinical Outcomes Research Initiative National Endoscopy Database (CORI-NED), a multicenter database that represents a broad section of endoscopy centers throughout the country, including community-based as well as academic settings. They identified all patients who underwent upper gastrointestinal endoscopy during the years 2004-2009 for one of the following reasons: Weight loss, iron deficiency, anemia, or diarrhea. "Any one of these symptoms could be compatible with celiac disease. We know that the blood tests for making this diagnosis are not perfect, and so we argue that most patients having an endoscopy for one of these reasons should have a biopsy of the small intestine to test for celiac disease."

In fact, physicians did a small bowel biopsy in only 43 percent of the more than 13,000 patients having an endoscopy during this 6 year period.

"We thought that biopsy rates would be higher, especially considering the increased public awareness of celiac disease," said Dr. Lebwohl. Although the rates increased somewhat over time, in the most recent year of the study (2009) the biopsy rate remained only 51 percent. "As a result, it remains possible that a patient with celiac disease may seek health care, see a gastroenterologist, and have an endoscopy, and yet may still remain undiagnosed."

These low biopsy rates were not uniform: men were less likely to have a biopsy as compared to women. This may provide a clue to understanding a long-observed curiosity: the lopsided gender ratio among patients with celiac disease.

"Men are just as likely as women to develop celiac disease, but women are much more likely to be diagnosed," said Peter H.R. Green, MD, professor of clinical medicine in the Division of Digestive and Liver Diseases, director of CUMC's Celiac Disease Center, and senior author of the study.

"Perhaps men aren't being diagnosed because their doctors aren't biopsying them, even when symptoms are compatible with celiac disease. This becomes a self-fulfilling prophecy: men aren't being biopsied, diagnosis rates in men remain low, and so doctors erroneously think that celiac disease is a 'woman's disease,'" said Dr. Green.

Biopsy rates were also lower among older patients, African-Americans, and Hispanics. Dr. Green added, "We know that celiac disease can occur at any age, and is not limited to Caucasians; but here again this celiac disease stereotype of the young Caucasian is reflected in the biopsy practices of gastroenterologists nationwide."

The authors are planning follow-up studies that aim to educate physicians regarding the benefits of performing small bowel biopsy.


Contact: Karin Eskenazi
Columbia University Medical Center

Related medicine news :

1. Hot Flashes Dont Signal Poor Heart Health for Most Women: Study
2. Study finds new gene mutations that lead to enlarged brain size, cancer, autism, epilepsy
3. Gay or Straight, Parents Too Tired for Sex, Study Suggests
4. Minorities Less Likely to Use Hospice Care: Study
5. Residents as Good as Fully Trained Docs if Properly Supervised: Study
6. Study calls for drug trial patients to receive more information about effects of placebos
7. Wake Forest Baptist study suggests Tasers dont cause cardiac complications
8. Study finds genes associated with hippocampal atrophy
9. Eating Vegetables May Protect Pancreas, Study Suggests
10. LA BioMed investigator Dr. Christina Wang spearheads study on new male contraceptive gel
11. UT Southwestern study shows treating diabetes early, intensively is best strategy
Post Your Comments:
(Date:11/30/2015)... ... November 30, 2015 , ... During the National ... caregivers and held two webinars on topics of ‘Medical and Palliative Care Decisions,’ ... at . , With a loved one's diagnosis of mesothelioma, the ...
(Date:11/30/2015)... ... November 30, 2015 , ... ... . The directory is specialized and only includes chiropractic clinics in the US. ... competent and trustworthy alternative health practitioner when back pain sets in. When people ...
(Date:11/30/2015)... ... November 30, 2015 , ... In an effort ... the Word of Life Christian Church of Flint, MI, hosted a family-oriented evening ... 1.25 ton pile of candy dubbed “Candy Mountain”. , A Forever Recovery, a ...
(Date:11/30/2015)... VA (PRWEB) , ... November 30, 2015 , ... ... Foundation kicked off its annual fundraising campaign to raise funds for its research, ... raises approximately 10% of the organization’s annual funding. , The Mesothelioma Applied Research ...
(Date:11/30/2015)... ... November 30, 2015 , ... The ... in Dallas, TX, on January 29 and 30, 2016. The course welcomes dental ... of their practices, to learn how to better succeed in the modern dental ...
Breaking Medicine News(10 mins):
(Date:11/30/2015)... 30, 2015 Diplomat Pharmacy, Inc. (NYSE: ... the Detroit Free Press as a Top Workplace , ... to work for in 2015. ... 100 winners annually, based on employee surveys rating company leadership, ... Workplaces are based solely on employee feedback. The survey is ...
(Date:11/30/2015)... , November 30, 2015 global cell ... of US$6.1 bn to US$11.3 bn by 2022 at a CAGR ... is expected to grow from its 2013 value of US$6.1 bn ... --> Transparency Market Research has announced the release of ... According to the report, titled ,Cell Culture Market - Global Industry ...
(Date:11/30/2015)... and BOCA RATON, Fla. , ... the Commercialization of Public Research (the Institute) announced ... KynderMed , a medical device start-up company with ... new company creation based on publicly-funded research, and bridges ... Florida -based universities and research institutions. ...
Breaking Medicine Technology: