Featured Research

from universities, journals, and other organizations

Low adherence to biopsy guidelines affects celiac disease diagnosis in the United States

Date:
July 7, 2011
Source:
Columbia University Medical Center
Summary:
A new study has found that most patients undergoing biopsy of the small intestine do not have the recommended number of samples to diagnose celiac disease.

A new study has found that most patients undergoing biopsy of the small intestine do not have the recommended number of samples to diagnose celiac disease. The study, published in the July 2011 issue of Gastrointestinal Endoscopy, analyzed a national database of biopsy specimens maintained by Caris Life Sciences (Irving, TX). More than 100,000 patients had a biopsy of the small intestine, but only 35 percent of them had at least four samples taken, the number recommended by professional guidelines.

Related Articles


Celiac disease is common, affecting approximately 1 percent of the population in the United States. However, the vast majority of patients with celiac disease in the United States have not been diagnosed. Many of these patients seek health care for symptoms including diarrhea, weight loss, or fatigue due to anemia. The diagnosis of celiac disease is made by biopsy of the small intestine, but factors related to the performance of biopsy may contribute to the under-diagnosis of celiac disease in the United States.

"Celiac disease can affect the small intestine in a patchy distribution, and so just one or two biopsy samples could potentially miss the evidence of the disease," said lead author Benjamin Lebwohl, MD, MS, a gastroenterologist at the Celiac Disease Center at Columbia University Medical Center, in New York. Dr. Lebwohl and co-authors aimed to measure the practice of small intestinal biopsy in the United States. The Caris pathology database consists of specimens submitted by gastroenterologists from 43 states as well as Puerto Rico and the District of Columbia. The team also compared the diagnosis rate among patients who had at least four specimens submitted, in accordance with guidelines.

The investigators identified 132,352 individuals who underwent biopsy between 2006 and 2009, for a variety of medical indications, including diarrhea, abdominal pain, esophageal reflux, and anemia. Only 35 percent of this group had at least four specimens submitted, and the most common number of specimens submitted was two. But adhering to the recommendation of submitting at least four specimens more than doubled the diagnosis rate of celiac disease.

Even when physicians indicated that they were suspicious of celiac disease (e.g., when patients had positive celiac disease blood tests), fewer than 40 percent of patients had at least four specimens submitted; the diagnosis was increased sevenfold when the guidelines were followed.

"The process of increasing the number of specimens from two to four takes approximately one extra minute during endoscopy," said Dr. Lebwohl. Given the high incremental yield of submitting at least four specimens, taking this extra minute appears to be justified.

"In this study we identified just one of the factors contributing to the high rate of under-diagnosis of celiac disease in the United States. We plan on studying other physician-related factors that may also be operative," said Dr. Peter Green, Director of the Celiac Center Columbia University Medical Center, who was also an author on the paper.


Story Source:

The above story is based on materials provided by Columbia University Medical Center. Note: Materials may be edited for content and length.


Journal Reference:

  1. Benjamin Lebwohl, Robert C. Kapel, Alfred I. Neugut, Peter H.R. Green, Robert M. Genta. Adherence to biopsy guidelines increases celiac disease diagnosis. Gastrointestinal Endoscopy, 2011; 74 (1): 103 DOI: 10.1016/j.gie.2011.03.1236

Cite This Page:

Columbia University Medical Center. "Low adherence to biopsy guidelines affects celiac disease diagnosis in the United States." ScienceDaily. ScienceDaily, 7 July 2011. <www.sciencedaily.com/releases/2011/07/110707092437.htm>.
Columbia University Medical Center. (2011, July 7). Low adherence to biopsy guidelines affects celiac disease diagnosis in the United States. ScienceDaily. Retrieved November 23, 2014 from www.sciencedaily.com/releases/2011/07/110707092437.htm
Columbia University Medical Center. "Low adherence to biopsy guidelines affects celiac disease diagnosis in the United States." ScienceDaily. www.sciencedaily.com/releases/2011/07/110707092437.htm (accessed November 23, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Sunday, November 23, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Ebola-Hit Sierra Leone's Late Cocoa Leaves Bitter Taste

Ebola-Hit Sierra Leone's Late Cocoa Leaves Bitter Taste

AFP (Nov. 23, 2014) The arable district of Kenema in Sierra Leone -- at the centre of the Ebola outbreak in May -- has been under quarantine for three months as the cocoa harvest comes in. Duration: 01:32 Video provided by AFP
Powered by NewsLook.com
Don't Fall For Flu Shot Myths

Don't Fall For Flu Shot Myths

Newsy (Nov. 23, 2014) Misconceptions abound when it comes to your annual flu shot. Medical experts say most people older than 6 months should get the shot. Video provided by Newsy
Powered by NewsLook.com
WFP: Ebola Risks Heightened Among Women Throughout Africa

WFP: Ebola Risks Heightened Among Women Throughout Africa

AFP (Nov. 21, 2014) Having children has always been a frightening prospect in Sierra Leone, the world's most dangerous place to give birth, but Ebola has presented an alarming new threat for expectant mothers. Duration: 00:37 Video provided by AFP
Powered by NewsLook.com
Could Your Genes Be The Reason You're Single?

Could Your Genes Be The Reason You're Single?

Newsy (Nov. 21, 2014) Researchers in Beijing discovered a gene called 5-HTA1, and carriers are reportedly 20 percent more likely to be single. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins