A case-control study of presentations in general practice before diagnosis of coeliac disease
Background: Delay in the diagnosis of coeliac disease prolongs morbidity and may increase mortality. Little is known about presentations in general practice that may predict a subsequent diagnosis of coeliac disease. Aim: To examine presentations in general practice during the 5 years prior to diagnosis of coeliac disease. Design of study A case-control study with each biopsy-proven coeliac disease case matched by age, sex, and general practice to an average of two controls. Setting: Thirty-seven general practices in south-east Wales. Method: Cases were identified via a secondary care clinic and controls recruited from the general practices of cases. General practice clinical records of both cases and controls were analysed to determine frequency of consultations, presenting symptoms, diagnoses, referrals, and investigations during the 5 years prior to diagnosis. Results: Cases (n = 68) had an increased number of consultations compared with controls (n = 160) during the 5 years prior to diagnosis (mean difference five consultations, P = 0.001). Three clinical features were independently associated with subsequent diagnosis of coeliac disease: depression and/or anxiety (odds ratio [OR] = 2.5, 95% confidence interval [CI] = 1.1 to 5.7, P = 0.031); diarrhoea (OR = 4.5, 95% CI = 2.0 to 10.0, P<0.001); and anaemia (OR = 26.3, 95% CI = 5.7 to 120.6, P<0.001). Both diarrhoea and anaemia remained associated even when data for the year prior to diagnosis was excluded from the analysis. Conclusion: Further research is required to clarify the role of depression in the diagnosis of coeliac disease. GPs should consider testing for coeliac disease when patients present often, especially with diarrhoea and/or who are discovered to be anaemic. Further research is required to clarify the role of depression and/or anxiety in the diagnosis of coeliac disease. © British Journal of General Practice.