Celiac Disease Under-Diagnosis Could Be Attributed To Low Biopsy Rates: Study

Celiac disease -- the condition that triggers an immune response to foods containing gluten -- has a reputation for being under-diagnosed in the United States. But why?

Columbia University Medical Center researchers may have a reason.

The team of scientists found that small bowel biopsies conducted during endoscopies are occurring at a low rate in the U.S., and this might be keeping people from a celiac disease diagnosis.

According to the A.D.A.M. Medical Encyclopedia, blood tests are first done to see if a person may have antibodies that could be a sign of celiac disease. Then, upper endoscopies are completed, with the purpose of obtaining a biopsy (a tissue sample) from a part of the small intestine to provide further confirmation of the condition.

"This study shows that some of these undiagnosed patients may be coming to see a gastroenterologist and still are not getting the biopsy they need for a diagnosis," said study researcher Dr. Benjamin Lebwohl, M.D., M.S., in a statement. Lebwohl is an assistant professor of clinical medicine in the Division of Digestive and Liver Diseases and a gastroenterologist and epidemiologist at the Celiac Disease Center at Columbia.

WebMD reported that just 5 percent of people who actually have celiac disease have been diagnosed. As many as one in 100 people may have the condition.

The study is published in the journal Gastrointestinal Endoscopy. While Lebwohl doesn't have any disclosures, it should be noted that some of his co-researchers are advisers and/or consultants, or have received past research funding from, pharmaceutical companies.

For the study, the researchers analyzed 2004 to 2009 data on upper gastrointestinal endoscopies conducted at a number of centers -- from academic institutions to community-based centers -- because of diarrhea, iron deficiency, weight loss or anemia, which could all be signs of celiac disease. The analysis included more than 13,000 people.

"We know that the blood tests for making this diagnosis are not perfect, and so we argue that most patients having an endoscopy for one of these reasons should have a biopsy of the small intestine to test for celiac disease," Lebwohl said.

However, researchers found that fewer than half -- 43 percent -- of the endoscopies included a biopsy. In 2009 in particular, 51 percent of endoscopy recipients had a biopsy.

In addition, they found that men, older people, African-Americans and Hispanics had lower rates of biopsies compared with women and/or Caucasians. They noted that these low biopsy rates could be feeding into the idea that celiac disease is more common in women and Caucasians.