HOW MANY HOSPITAL VISITS DOES IT TAKE BEFORE CELIAC SPRUE IS DIAGNOSED

We studied the hospital records of patients with celiac sprue in order to determine how frequently hospital specialists failed to make the d iagnosis. Over a 7 1/2-year period, 39 patients were diagnosed, 49% wi thin the last is months of the study period. Fourteen patients (39%) h ad been referred to the hospital a total of 30 times with features sug gestive of celiac sprue, yet without being successfully diagnosed: the delay between initial referral and diagnosis was >6 years in nine of these patients. The diagnosis was made by gastroenterologists or other internists in 38 (97%) patients. Gastroenterologists had an 85% (33 o f 39) diagnostic success rate, other internists 63% (five of eight), a nd surgeons 7% (one of 14). None of eight referrals to other specialis ts led to diagnosis. While a history of diarrhea was more likely to le ad to diagnosis, it was reported by only 59% (23 of 39) of patients at the time of diagnosis and at only 46% (32 of 69) of referrals; furthe rmore, it did not prompt correct diagnosis in 28% (nine of 32). Anemia was the sole manifestation of celiac sprue at 17 referrals, and corre ct diagnosis was made in only seven (41%), all by gastroenterologists. The perceived rarity of celiac sprue reflects its underdiagnosis. Dia gnosis is still delayed even in patients with classic diarrhea, and th ere is still a failure to appreciate the possible manifestations of sp rue, including anemia without gastrointestinal symptoms. Because patie nts may be referred to specialists other than gastroenterologists with symptoms arising from celiac sprue, a wider knowledge of its manifest ations is called for.