Coeliac disease in primary care: case finding study
Coeliac disease in primary care: case finding study
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DOI：
10.1136/bmj.318.7177.164
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发表时间：
1999-01-16
影响因子：
105.7
通讯作者：
Jewell, D
中科院分区：
文献类型：
--
作者：
Hin, H;Bird, G;Jewell, D
目的提供乳糜泻漏诊的证据，并描述乳糜泻在初级保健中的主要表现症状。设计在初级保健机构中使用肌内膜抗体试验检测乳糜泻病例。在英格兰中部的一个集镇及其周边地区进行了9次手术，为7万人口提供服务。1996年10月至1997年10月筛选的首批1000名患者。结果测量：测定符合研究标准的患者的肌内膜抗体滴度，然后对结果阳性的患者进行小肠活检。结果1000例患者中肌内膜抗体试验阳性的30例患者均有小肠活检组织学证实，最常见的表现形式为不同程度的贫血（15/30）。大多数患者（25/30）表现为非胃肠道症状。肌内膜抗体试验特异性为30/30。结论乳糜泻的漏诊和误诊在全科医生中很常见，往往导致长期和不必要的发病。初级保健中的血清学筛查将发现很大一部分患有这种疾病的患者，应广泛提供并进行宣传。有贫血或常年疲劳的患者应考虑乳糜泻，特别是有家族病史的患者。
Objectives To provide evidence of underdiagnosis of coeliac disease and to describe the main presenting symptoms of coeliac disease in primary care.Design Case finding in a primary care setting by testing for coeliac disease by using the endomysial antibody test.Setting Nine surgeries in and around a market town in central England, serving a population of 70 000.Participants First 1000 patients screened from October 1996 to October 1997.Outcome measures Determination of endomysial antibody titre of patients fulfilling the study criteria, followed by small intestine biopsy of those with positive results.Results The 30 patients (out of 1000 samples) with positive results on the endomysial antibody test all had histological confirmation on small intestine biopsy The commonest mode of presentation (15/30) was anaemia of varying severity. Most patients (25/30) presented with non-gastrointestinal symptoms. Specificity of the endomysial antibody test was 30/30.Conclusions Underdiagnosis and misdiagnosis of coeliac disease are common in general practice and often result in protracted and unnecessary morbidity. Serological screening in primary care will uncover a large proportion of patients with this condition and should be made widely available and publicised. Coeliac disease should be considered in patients who have anaemia or are tired all the time, especially when there is a family history of the disease.