Factors associated with long diagnostic delay in celiac disease

Abstract

Objective. Here, we investigated the factors associated with long diagnostic delay in celiac disease and the impact of the national Current Care Guidelines in reducing the delay. Material and methods. This population-based study involved 825 adult celiac disease patients. The diagnosis was considered delayed when the interval between first symptoms and diagnosis was >10 years. The patients were asked about the duration and type of symptoms before diagnosis, time and site (tertiary, secondary, or primary care) of the diagnosis, family history of the disease, and presence of significant comorbidities. Analysis was performed by binary logistic regression. Results. Altogether, 261 (32%) out of 825 participants reported a diagnostic delay of >10 years. Female gender, neurological or musculoskeletal disorders and presence of diarrhea, abdominal pain, and malabsorption were associated with prolonged delay. Male gender, diagnosis after the introduction of the first Current Care Guidelines in 1997, and being detected by serological screening, and family history of celiac disease were associated with a lower risk of delayed diagnosis. Factors not associated with the delay were site of diagnosis, age, and presence of dermatitis herpetiformis, type 1 diabetes, or thyroidal disease. Conclusion. The number of long diagnostic delays in celiac disease has decreased over the past decades. The shift of diagnostics from secondary and tertiary care to primary care has not been detrimental. National guidelines together with increased awareness and active screening in at-risk groups of celiac disease are important in these circumstances.

Key Words::

• adults
• celiac disease
• current care guidelines
• diagnostic delay

Acknowledgements

This study was supported by the Academy of Finland Research Council for Health, the Competitive State Research Financing of the Expert Responsibility Areas of of Tampere University Hospital (Grants 9P060, 9R018, and Seinäjoki Central Hospital Grant VTR16), the Sigrid Juselius Foundation, the Foundation for Paediatric Research, the Finnish Medical Foundation and Elna Kaarina Savolainen’s and Seppo Nieminen’s funds allocated for the development of cancer treatment.

Declaration of interest: The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.