Multinational Survey Reveals Knowledge Gap Among PCPs on Celiac Disease

While gastroenterologists (GIs)and primary care physicians (PCPs) provide diagnosis and management of celiac disease (CeD), a survey of physicians in the US, Spain, Italy, and Germany revealed importance distinctions between these clinician groups in regard of knowledge of the disease and approaches to diagnosing and managing CeD patients, according to a poster presented at Digestive Disease Week in Chicago, Illinois on May 6.

The authors extracted data from the Adelphi Disease Specific Programme™ for CeD, described as “a point in time survey” of gastroenterologists and PCPs actively involved in the US from July 2021 to January 2022. “Each physician completed an attitudinal survey pertaining to their treatment practices, covering themes regarding methods to diagnose and monitor CeD, factors determining disease progression, severity, and remission as well as perceptions on villus atrophy and gluten intake,” the authors noted.

The analysis included survey responses from 178 gastroenterologists and 100 PCPs. The gastroenterologists reported more use of biopsies, blood tests, and imaging tests in conducting patient diagnosis compared to PCPs (p<0.05); the trends for monitoring were similar. “Use of the Marsh classification was low among PCPs, with 70% stating they do not use the measure, compared to 26% of GIs (p<0.01). Regardless of the level of villus atrophy, PCPs stated that they did not know whether villus atrophy was reversible or not among a higher proportion of patients than GIs (p<0.01). GIs were more likely than PCPs to take villus atrophy into account when measuring disease progression (GI 75%, PCP 47%, p<0.01), determining disease severity (GI 75%, PCP 54%, p<0.01), and determining remission status (GI 72%, PCP 51%, p<0.01). “

The two groups of clinicians also reported differences in their perceptions of the safe level of gluten intake for patients with celiac disease; 58% of GIs reported that there is no safe level of gluten for CeD patients, compared to just 35% of PCPs, while 17% of PCPs did not know if gluten intake is acceptable for nonsymptomatic patients vs 8% of GIs (p=0.02).

One point on which the two groups largely agreed, however, was the need for greater awareness of CeD and more education about the disease. The authors reported that “60% of GIs and 50% of PCPs stated that increased awareness and education of PCPs was the main attribute that would help facilitate the early diagnosis of CeD.”
 

The authors concluded, “This study demonstrates that there are differences between GIs and PCPs in diagnosing and managing patients with CeD, with a large knowledge gap observed among PCPs. This highlights a need for further education to improve the consistency of care received by CeD patients.”

—Rebecca Mashaw

Reference:

HarveyN, KnightH, MeadowsR, et al.  Physician management of celiac disease: a comparison of disease knowledge, diagnosis, and patient management between gastroenterologists and primary care physicians in Germany, Italy, Spain, and the United States – Findings from a real-world survey. Presentation