Coeliac disease in primary care: case finding study

Objectives To provide evidence of underdiagnosis of coeliac disease and to describe the main presenting symptoms of coeliac disease in primary care. Design Case finding in a primary care setting by testing for coeliac diseas e by using the endomysial antibody test. Setting Nine surgeries in and around a market town in central England, serv ing a population of 70 000. Participants First 1000 patients screened from October 1996 to October 1997 . Outcome measures Determination of endomysial antibody titre of patients ful filling the study criteria, followed by small intestine biopsy of those wit h positive results. Results The 30 patients (out of 1000 samples) with positive results on the endomysial antibody test all had histological confirmation on small intesti ne biopsy The commonest mode of presentation (15/30) was anaemia of varying severity. Most patients (25/30) presented with non-gastrointestinal sympto ms. Specificity of the endomysial antibody test was 30/30. Conclusions Underdiagnosis and misdiagnosis of coeliac disease are common i n general practice and often result in protracted and unnecessary morbidity . Serological screening in primary care will uncover a large proportion of patients with this condition and should be made widely available and public ised. Coeliac disease should be considered in patients who have anaemia or are tired all the time, especially when there is a family history of the di sease.