The Recognition, Diagnosis, and Management of Coeliac Disease in New Zealand.

Abstract

Background Coeliac disease, an autoimmune-mediated sensitivity to gluten, is known to affect at least 1% of the population. It is widely acknowledged that it is underdiagnosed, and that management beyond the implementation of a gluten-free diet is inconsistent, despite there being several guidelines now available. This study investigated these issues as they relate to the New Zealand context, testing the hypothesis “that general practitioners in New Zealand have limited disease-specific knowledge about coeliac disease.”

Methods Surveys of New Zealand general practitioners and gastroenterologists were undertaken, investigating their likely practices with respect to a range of variables associated with the recognition, diagnosis, and management of coeliac disease. Nine years of data from one of New Zealand’s major laboratories, relating to testing for coeliac disease were also audited.

Results General practitioners in New Zealand have patchy knowledge about whom to test for coeliac disease, and how to diagnose and manage the condition. There is also a lack of consistency among gastroenterologists about aspects of its management. However, rates of testing for coeliac disease have steadily increased over time in the majority of regions examined, and its incidence is high in Otago-Southland. Furthermore, when people with very high coeliac antibody levels are biopsied, they almost always have evidence of coeliac disease.

Conclusions General practitioners in New Zealand do have gaps in their knowledge about coeliac disease. Agreeing on a set of New Zealand-specific practice guidelines to promote consistent practice among clinicians, targeting gaps in knowledge, and reviewing policies around who should undergo biopsy to confirm the diagnosis, could all improve outcomes for patients with this condition.