Introduction Patients with coeliac disease (CD) are usually stable clinically and biochemically at their annual review. Due to pressures on out-patient services we reviewed data to assess which patients actually require specialist gastrointestinal (GI) input, and raise the question as to who should see CD patients in clinics.
Method Barnet Hospital is a District Hospital serving a population of 5 00 000 just outside North West London. This was a single centre, retrospective study of confirmed CD patients, under the care of three different gastroenterologists. Data was obtained from each consultant from their database. We reviewed the electronic records relating to each patient‘s last three clinic appointments, and assessed whether or not they were stable clinically and biochemically. We excluded patients with other significant GI co-morbidities and those who were newly diagnosed within the last two years.
Results There were 192 patients with CD of whom, 160 fulfilled the inclusion criteria (F=107;67%). In each of the last 3 clinic reviews, 83% (n=133) were stable.
Only 17% (n=27) required GI input, including 18% (n=7) due to poor adherence to a gluten free diet, 28% (n=11) due to GI symptoms, 18% (n=7) due to weight loss, 18% (n=7) due to anaemia, 8% (n=3) due to elevated TTG and 10% (n=4) other.
Annual reviews by a gastroenterologist occurred in 83% (n=133). Dieticians saw patients less than once per year in 62.5% (n=100) of cases, and 37.5% (n=60) were actually never referred to a dietician.
Conclusion BSG guidelines recommend that patients with CD are seen annually by a dietician and/or clinician for a clinical review, biochemical checks and for dietary adherence and advice1. NICE guidelines also state that patients should be seen annually for clinical review, height and weights check, bloods and to assess the need for nutritional advice2.
We have demonstrated that in a hospital that does not have a dietician led coeliac service, gastroenterologists typically see straight forward and stable patients annually 83% of the time. Assuming a 10 min follow-up slot, this equates to 22 hours per annum of specialist time, equivalent to 6.3 clinics each year.
Given the need to access our services for urgent referrals or unwell patients with other conditions, this study forms the basis for a business case to set up a dietician led coeliac service, with access to gastroenterologists only where needed.
. Coeliac disease: recognition, assessment and management. NICE guideline [NG20]. Sept 2015
. Ludvigsson JF, et al. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut2014;63:1210–28.
Disclosure of Interest None Declared
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