Low biopsy rates may be the reason for underdiagnosis of coeliac disease in the US

Many people with coeliac disease in the US are not being diagnosed, compared to the high rates of diagnosis in Western Europe and Scandinavia. Rather than patients with coeliac disease not seeking medical attention, it looks more likely that those patients are simply not getting the biopsy that they need for diagnosis.

The study, published in Gastrointestinal Endoscopy, led by Dr Benjamin Lebwohl, a gastroenterologist and epidemiologist at the Coeliac Disease Centre, identified all patients who had an upper gastrointestinal endoscopy between 2005-2009 or weight loss, iron deficiency, anaemia or diarrhoea. Any of these could be a symptom of coeliac disease, however blood tests to identify coeliac disease are not always conclusive, therefore should a patient present with any one of these symptoms, Lebwohl recommends a biopsy be carried out.

Of the 13,000 people who had an endoscopy for the symptoms above, only 43% went on to have a biopsy. The researchers saw that men were less likely to have a biopsy than women, which may be a reason why coeliac disease is thought to be more prevalent among women. There are also lower biopsy rates among African-American, Hispanics and older people, possibly because coeliac disease is thought to be a Caucasian disease, which may in turn influence the low biopsy rates in non-Caucasians.

The outcome of the research is to educate doctors about the benefits of small biopsies, and to this end the researchers will be continuing their studies.

Source: Gastrointestinal Endoscopy

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