Survey of the initial management of celiac disease antibody tests by ordering physicians

Autor: Dominica Gidrewicz, J. Decker Butzner, Lawrence de Koning, Kathryn Potter
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
Tissue transglutaminase
Biopsy
Psychological intervention
Disease
Autoantigens
Pediatrics
Serology
Alberta
0302 clinical medicine
Diagnosis
Celiac disease
030212 general & internal medicine
Practice Patterns
Physicians'
Child
Referral and Consultation
Pediatric
biology
medicine.diagnostic_test
Gastroenterology
lcsh:RJ1-570
Disease Management
Ordering Physician
Prescriptions
Child
Preschool
Female
Antibody
Symptom Assessment
Research Article
medicine.medical_specialty
Referral
Adolescent
Attitude of Health Personnel
03 medical and health sciences
Diet
Gluten-Free
GTP-Binding Proteins
030225 pediatrics
Internal medicine
medicine
Humans
Protein Glutamine gamma Glutamyltransferase 2
Autoantibodies
Transglutaminases
business.industry
Infant
lcsh:Pediatrics
Health Care Surveys
Pediatrics
Perinatology and Child Health
biology.protein
business
Zdroj: BMC Pediatrics, Vol 19, Iss 1, Pp 1-6 (2019)
BMC Pediatrics
ISSN: 1471-2431
DOI: 10.1186/s12887-019-1621-5
Popis: Background Appropriate interpretation of a positive celiac antibody test by an ordering physician is important in order to institute proper management. We evaluated why children with an initial positive celiac serology were not referred for diagnostic biopsy or followed with serial testing by the ordering physician. Methods Consecutive celiac serologies in all patients less than 18 years of age were evaluated over 3.5 years and 775 children with a positive tissue transglutaminase antibody (TTG) were identified. If no management of a positive TTG could be identified, a survey was sent to the ordering physician. Responses were categorized as appropriate or inappropriate management. Results Of the 775 patients with a positive TTG, 193 (24.9%, 95% CI 21.9–28.1%) received no follow-up management. We contacted 173 ordering physicians and 120 (69%) responded. Of the 120 responses, 55 patients (45.8%, 95% CI 36.8–55.1%) were managed appropriately and 46 (38.3%, 95% CI 29.7–47.7%) were considered to be inappropriately managed when no repeat TTG was obtained within 18 months. Reasons for inappropriate management included: screen considered to be false positive (44.7%), patient was not experiencing symptoms of celiac disease (31.6%), symptoms had resolved (15.8%), results were not indicative of celiac disease (26.3%) and patients started a gluten-free diet with no evaluation of response (15.8%). In 19 patients the TTG was not acted upon for technical reasons. Conclusions Positive TTGs require appropriate interventions. These include: subspecialist referral for further evaluation and/or repeat testing to evaluate: 1) treatment response or 2) patients with minimal or no symptoms. Electronic supplementary material The online version of this article (10.1186/s12887-019-1621-5) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
Externí odkaz: