High rates of serology testing for coeliac disease, and low rates of endoscopy in serologically positive children and adults in Israel: Lessons from a large real-world database

Anat Guz-Mark, Becca S. Feldman, Adi Ghilai, Moshe Hoshen, Herman Avner Cohen, Vered Shkalim Zemer, Amit Assa, Noam Zevit, Raanan Shamir

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Although coeliac disease is common worldwide, little is known regarding screening patterns in unselected populations, and on real-life adherence to professional guidelines for coeliac disease diagnosis and management. Objective: To explore current practices in the diagnosis and management of coeliac disease, using data from a large Health Maintenance Organization in Israel that covers 54% of the population. Methods: A population-based electronic database of about 4.5 million individuals was reviewed during the period of 1 January 2008 to 31 December 2015. Rates and results of coeliac disease serology testing and endoscopy procedures were examined. Subgroup analysis was performed by age, sex, ethnicity and socioeconomic status. Results: Coeliac disease serology cumulative testing rate was 17.1% and 8.9% in the paediatric and adult population, respectively. The cumulative incidence of positive coeliac disease serology was 0.45% in children and 0.17% in adults, and was associated with age, sex, ethnicity and socioeconomic status sub-groups (P-value < 0.01). Gastrointestinal endoscopies were not subsequently performed in 44.1% of children and 47.1% of adults with positive coeliac disease serology. Within the study period, 36% of children and 56% of adults never achieved coeliac disease serology normalization. Conclusion: In a large real-life database, screening for coeliac disease was common. However, confirmatory intestinal biopsies were under-utilized, and coeliac disease serology often remained positive over a long period time in both children and adults.

Original languageEnglish
Pages (from-to)329-334
Number of pages6
JournalEuropean Journal of Gastroenterology and Hepatology
Volume32
Issue number3
DOIs
StatePublished - 1 Mar 2020

Keywords

  • coeliac disease
  • coeliac guidelines
  • duodenal endoscopy
  • serology normalization
  • socioeconomic status
  • tissue transglutaminase

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