Year: 2021
Type: conference-paper
Study design: Observational Study
Abstract: Introduction The BSG and NICE recommend long-term regular follow-up of patients with Coeliac disease (CD). It is unclear when and what to be done when following a newly diagnosed CD patient and who should perform this review. The Northern Nutrition Network is multi-disciplinary, meets regularly and involves all acute Trusts in the north-east and north Cumbria. It is recommended that we check FBC, U&Es, LFTs, bone profile, Vit D and CD serology. Aim To assess the follow up of patients with CD across the region. Method A retrospective review of CD follow up using patient’s records. All regional acute Trusts were invited to participate. A questionnaire was developed and circulated. Follow up data, for upto 2 years after the diagnosis of CD, were recorded for up to 20 patients per Trust, diagnosed after 1.1.2017. Results 141 responses received from 8 of 9 trusts. Median age was 41 years. 38% (54/141) were male. Histology was consistent with CD in all patients. EMA was positive when tested in 92%, negative in 8% - not tested 17%. TTG was positive when tested in 95%, negative in 5% - not tested in 6%. TTG values varied from 6.4U/ml to >1000 U/ml. Following diagnosis, 70% of CD patients were followed up by gastroenterologists in first 4 months, 88% in their first year and 89% in 2 years. Only 11% (16/141) did not see a gastroenterologist in the first 24 months after diagnosis. 90% of CD patients were seen by dietician in first 4 months, 91% in first year and 91% in 2 years following diagnosis. 9% were not seen by dietician. There were 2 trusts in which patients were followed up by nurse specialist as well. Weight was measured at review in 92% in 1st year and 71% in 2nd year. BMI was recorded for 71%. Dietary compliance was recorded in 85% at review: 60% were fully compliant to gluten free diet (GFD), 15% had occasional lapses, only 10% were not compliant. 4% did not have FBC or LFTs and 2% U&Es checked in first 24 months. 12% did not have calcium and 41% did not have Vit D checked in first 24 months. Serology was checked in 83% in 1st year, 53% in the 2nd year, 12% did not have serology in first 24 months. Following review of blood tests results, actions taken on abnormal results: Folic acid supplemented 6 times, Vit D supplemented 17 times, Iron 15 times, Vit B12 4 times and Calcium 3 times. Repeat duodenal biopsy was undertaken within 2 years in 15% of patients. Estimation of fracture risk was recorded in 16% but BMD measurement within 2 year was in 66%. In 18% advice was given on vaccination during the review. Conclusion Practice in the follow-up of patients with CD varied. Blood tests are checked regularly but we are poor in recording vaccination advice and perform BMD rather than estimate fracture risk non-invasively. Repeat duodenal biopsy is unusual. There is a need of robust follow up regimens across the region.
Authors: Mohammed Adnan Khan, E Sainsbury, E Johns, D Hobday, L Walker, J Ross, David Oliver, Chris Wells, D Smith, NP Thompson
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W3214718588