Testing for celiac disease (CD) in patients with unexplained iron deficiency anemia (IDA) appears to be underutilized by primary care physicians (PCPs), according to results of a national survey.

PCPs belonging to the American College of Physicians received the survey electronically. Several scenarios were presented in order to evaluate the differences in approaches to testing for CD based on the age, gender, and race of the patient. The respondents were asked whether they would test for CD (serologic testing, refer for esophagogastroduodenoscopy (EGD), or refer to GI) in  cases of new IDA in (1) a young Caucasian man, (2) a premenopausal Caucasian woman, (3) an elderly Caucasian man, and (4) a young African American man. 

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The results of the survey found a significant difference in the frequency of testing for CD based on a patient’s characteristics. For example, the subgroup that was most frequently tested was young Caucasian men, with 61% of respondents stating that they would implement serologic testing in this group (P<0.001). Additionally, it was found that 80% of respondents would “definitely or “probably” initiate a gluten-free diet before obtaining a confirmatory upper endoscopy in a patient with positive serologies, which is contrary to guideline recommendations.

“PCPs are under-testing for CD in patients with IDA, regardless of age, gender, race, or post-menopausal status,” the concluded the authors. Additionally, most PCPs do not follow guideline recommendations regarding a follow up duodenal biopsy in a patient with a positive serology for CD.

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