Gluten Intolerance Is Underdiagnosed

January 15, 1999

(Coeliac disease in primary care: case finding study)

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Underdiagnosis and misdiagnosis of coeliac disease (gluten intolerance) are not uncommon in general practice in the UK and lead to unnecessary suffering in patients, say Dr Harold Hin and colleagues from Oxfordshire in this week's BMJ.

Sufferers of coeliac disease should avoid products containing gluten, which is a protein found in wheat, rye and some other cereals. The symptoms of coeliac disease include anaemia and feeling tired all the time and is particularly relevant in those with a family history of the disease. Misdiagnosing the tired patient as having chronic fatigue syndrome is a potential pitfall. Irritable bowel syndrome is another, albeit rare, presentation, say the authors. This disease is treatable and has serious preventable long term complications, such as osteoporosis, infertility and cancer.

In a selective survey of 1000 people in central England, the authors found that 30 patients had coeliac disease. They found that the average age of adult diagnosis was 44 years and they refer to previous research which suggests that almost half of patients who are diagnosed with coeliac disease in adult life have visited their doctor for an average of 28 years with unexplained symptoms or blood test abnormalities.

Hin et al conclude that general practitioners should consider testing patients for coeliac disease using the highly reliable antibody blood test (endomysial), if they consult with them about feeling tired all the time and have unexplained anaemia.


Dr Harold Hin, General Practitioner, Hightown Surgery, Banbury, Oxfordshire

t: +44 1295 270722 or home: 262398

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