Physician Awareness of Celiac Disease

A Need for Further Education


  • The authors have no conflicts of interest to report.
    This paper was presented in part at the 68th Annual Meeting of the American College of Gastroenterology, October 10–15, 2004, Baltimore, Md.

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Background: Celiac disease is a common disorder (up to 0.7%); however, it is uncommonly diagnosed in the United States.

Objective: We sought to determine physician awareness of celiac disease.

Design: Surveys completed by 2,440 (47%) of 5,191 patients in a support group were analyzed for frequency of diagnosis by physician specialties. Questionnaires were then sent to primary care physicians (PCPs) (n=132) in a southern California county to assess knowledge of celiac disease.

Results: In patient surveys, only 11% were diagnosed by PCPs (internists and family physicians) versus 65% by gastroenterologists. Physician surveys (70% response) showed that only 35% of PCPs had ever diagnosed celiac disease. Almost all physicians (95%) knew of wheat intolerance, but few (32%) knew that onset of symptoms in adulthood is common. Physicians were well aware (90%) of diarrhea as a symptom, but fewer knew of common symptoms of irritable bowel syndrome (71%), chronic abdominal pain (67%), fatigue (54%), depression and irritability (24%) or of associations with diabetes (13%), anemia (45%) or osteoporosis (45%), or of diagnosis by endomysial antibody tests (44%).

Conclusions: Lack of physician awareness of adult onset of symptoms, associated disorders, and use of serology testing may contribute to the underdiagnosis of celiac disease.