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Pancheva R, Dolinsek J, Panayotova M, Yankov I, Kofinova D, Nikolova S, Baycheva M, Georgieva M. Bridging the Gap: Awareness, Knowledge, and Challenges of Living with Celiac Disease in Bulgaria. Nutrients 2025; 17:1267. [PMID: 40219023 PMCID: PMC11990572 DOI: 10.3390/nu17071267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2025] [Revised: 03/31/2025] [Accepted: 04/02/2025] [Indexed: 04/14/2025] Open
Abstract
Background: Celiac disease (CD) is a chronic immune-mediated systemic disorder induced by gluten in genetically predisposed individuals, requiring lifelong management through a strict gluten-free diet (GFD). Although its global prevalence is around 1%, awareness and diagnosis remain suboptimal, contributing to challenges in disease management. Objectives: To assess the awareness, knowledge, and experiences of Bulgarian CD patients and caregivers regarding CD, diagnosis, and dietary adherence. Methods: A structured survey was conducted to evaluate patient and caregiver knowledge, awareness, and experiences with CD, focusing on the diagnostic process and dietary practices. Data were collected from a sample of Bulgarian CD patients and their caregivers. Results: The majority of the 191 respondents (94%) recognized CD as a lifelong condition, but only 26.7% correctly identified its autoimmune, systemic nature. The average diagnostic delay was 8.1 months, with over 50% of patients relying on serological tests alone, consistent with recent non-biopsy guidelines. Dietary adherence was significantly hindered by misconceptions about gluten-containing grains and societal barriers. Notably, 83.6% of participants reported bringing their own food when eating outside. Conclusions: The findings underscore the need for targeted public health initiatives, enhanced healthcare provider training, and improved dietary education to address knowledge gaps, expedite diagnosis, and improve dietary adherence. Such interventions could help reduce the psychosocial burden of CD and enhance the quality of life for affected individuals.
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Affiliation(s)
- Rouzha Pancheva
- Department of Hygiene and Epidemiology, Faculty of Public Health, Prof. Paraskev Stoyanov Medical University, 9000 Varna, Bulgaria
| | - Jernej Dolinsek
- Department of Pediatrics, University Medical Center Maribor, 2000 Maribor, Slovenia;
- Department of Pediatrics, Medical Faculty, University of Maribor, 2000 Maribor, Slovenia
| | - Marlena Panayotova
- Department of Pediatrics, Faculty of Medicine, Trakia University, 6000 Stara Zagora, Bulgaria;
| | - Ivan Yankov
- Department of Pediatrics, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria;
| | - Denitza Kofinova
- Department of Pediatric Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine “N.I. Pirogov”, 1000 Sofia, Bulgaria;
| | - Silviya Nikolova
- Department of Social Medicine and Healthcare Organization, Faculty of Public Health, Prof. Paraskev Stoyanov Medical University, 9000 Varna, Bulgaria;
| | - Mila Baycheva
- Department of Gastroenterology and Hepatology, University Children’s Hospital, Medical Univerity of Sofia, 1000 Sofia, Bulgaria;
| | - Miglena Georgieva
- Department of Pediatrics, Faculty of Medicine, Prof. Paraskev Stoyanov Medical University, 9000 Varna, Bulgaria;
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Nawaiseh HK, McKyer LJ, Abdelrahim DN, Al-Domi HA, AL-Nawaiseh FK, AL-Assaf MS, AL-Nadi SAA. Assessment of Knowledge of Celiac Disease and Associated Conditions Among Dietitians in Jordan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2025; 22:442. [PMID: 40238529 PMCID: PMC11941886 DOI: 10.3390/ijerph22030442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Revised: 02/27/2025] [Accepted: 03/06/2025] [Indexed: 04/18/2025]
Abstract
BACKGROUND Celiac disease (CD) is a type of systemic autoimmune condition triggered by gluten consumption among genetically predisposed individuals. AIM To assess the knowledge, awareness, and practices pertaining to CD and associated conditions among dietitians in Jordan. METHOD A cross-sectional web-based survey was carried out between April and October 2023. The survey was an internet-based questionnaire with closed-ended questions. RESULTS The majority of dietitians answered correctly that CD is caused due to an immunological reaction to gluten, gliadin, and protamine (91.7%); it is an autoimmune disease (71.2%); and the risk of developing an autoimmune disease is higher among CD patients (78.8). The majority of respondents (93.6%) correctly identified that a strict gluten-free diet is the treatment approach for CD patients. However, only (18.9%) of dietitians correctly identified the FDA guidelines for "Gluten Free" food labeling. Approximately 53.4% of respondents identified immunoglobulin (IgA) antibody testing as the most reliable way to diagnose patients with CD. CONCLUSIONS The dietitians have a good understanding of CD topics. The development of credentials in CD would ensure that dietitians practicing in CD are skilled.
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Affiliation(s)
- Hala K. Nawaiseh
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman 11942, Jordan; (H.A.A.-D.); (S.A.A.A.-N.)
| | - Lisako J. McKyer
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX 76107, USA;
| | - Dana N. Abdelrahim
- Research Institute for Medical and Health Sciences, Sharjah University, Sharjah 27272, United Arab Emirates;
| | - Hayder A. Al-Domi
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman 11942, Jordan; (H.A.A.-D.); (S.A.A.A.-N.)
| | | | - Mohammad S. AL-Assaf
- Department of Ears, Nose and Throat, King Hussein Medical Centre (KHMC), Amman 11941, Jordan;
| | - Shatha A. Abu AL-Nadi
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman 11942, Jordan; (H.A.A.-D.); (S.A.A.A.-N.)
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Vázquez-Polo M, Navarro V, Larretxi I, Perez-Junkera G, Lasa A, Miranda J, Churruca I. Effectiveness of a nutrition education programme for individuals with celiac disease and their supporters through social media (GLUTLEARN project). Comput Biol Med 2025; 184:109505. [PMID: 39626476 DOI: 10.1016/j.compbiomed.2024.109505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 10/24/2024] [Accepted: 11/27/2024] [Indexed: 12/22/2024]
Abstract
INTRODUCTION Social media has become a popular tool for patients with Celiac Disease (CD) to find information about their disease. However, limited research has been conducted to evaluate the impact of information shared on social media, specifically regarding CD. OBJETIVE This study aimed to assess the effectiveness of a nutrition education program on CD and gluten-free diet (GFD) delivered through social networks by experts in the field. METHOD The program, called GLUTLEARN, was delivered over six weeks via Instagram to individuals with CD and their supporters (people involved in the care of individuals with CD). Pre and post-intervention questionnaires were used to evaluate the program's effectiveness. RESULTS A total of 93 participants (63 with CD, 30 supporters), predominantly female (92.5 %) and European (93.5 %), took part in the program. GLUTLEARN has been found to be effective in improving the knowledge of people with CD and their supporters and improving attitudes among individuals. Furthermore, they showed a high level of concern about the disease and an interest in continuous learning. CONCLUSION Social networks give advantages for promoting nutrition education. Nevertheless, it is important to feed these nets with reliable information. The GLUTLEARN program is a valuable method for delivering reliable and current education about CD and the GFD, which leads to better disease control. It would be beneficial for more interventions to focus not only on individuals with CD but also on those who are avoiding gluten for various reasons or are involved in their care.
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Affiliation(s)
- Maialen Vázquez-Polo
- Gluten 3S Research group, Area of Nutrition and Food Science, Department of Pharmacy and Food Sciences, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Nutrition and Food Safety Group, Vitoria-Gasteiz, Spain
| | - Virginia Navarro
- Gluten 3S Research group, Area of Nutrition and Food Science, Department of Pharmacy and Food Sciences, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Nutrition and Food Safety Group, Vitoria-Gasteiz, Spain.
| | - Idoia Larretxi
- Gluten 3S Research group, Area of Nutrition and Food Science, Department of Pharmacy and Food Sciences, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Nutrition and Food Safety Group, Vitoria-Gasteiz, Spain
| | - Gesala Perez-Junkera
- Gluten 3S Research group, Area of Nutrition and Food Science, Department of Pharmacy and Food Sciences, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Nutrition and Food Safety Group, Vitoria-Gasteiz, Spain
| | - Arrate Lasa
- Gluten 3S Research group, Area of Nutrition and Food Science, Department of Pharmacy and Food Sciences, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Nutrition and Food Safety Group, Vitoria-Gasteiz, Spain
| | - Jonatan Miranda
- Gluten 3S Research group, Area of Nutrition and Food Science, Department of Pharmacy and Food Sciences, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Nutrition and Food Safety Group, Vitoria-Gasteiz, Spain
| | - Itziar Churruca
- Gluten 3S Research group, Area of Nutrition and Food Science, Department of Pharmacy and Food Sciences, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Nutrition and Food Safety Group, Vitoria-Gasteiz, Spain
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Agarwal S, Prasad S, Agarwal A, Raja Ali RA, Leffler DA, Green PHR, Sanders DS, Anderson RP, Ahuja V, Mulder CJJ, Makharia GK. Celiac disease care differs significantly between high- and low-middle-income countries: a global survey of celiac experts from 63 countries. J Gastroenterol Hepatol 2025; 40:142-152. [PMID: 39528309 DOI: 10.1111/jgh.16793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 08/02/2024] [Accepted: 10/21/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND AND AIM Celiac disease (CeD) is increasingly diagnosed but significant disparities exist in awareness, practices, resources, and legislation worldwide. We conducted a global online survey with CeD experts to assess this disparity internationally. METHODS A 55 questions survey encompassing nine domains relevant to CeD care (awareness, gluten-free [GF] foods availability/cost/quality, GF labeling, CeD dietician availability, insurance for CeD patients, medical training, research funding, patient support groups, and unmet needs) was generated and sent to CeD experts worldwide electronically. Countries were stratified based on per capita income as high-income (HIC) and lower-income countries (LIC) (including upper-middle-, lower-middle-, and low-income countries). Survey responses were summarized as a single score using principal component analysis. RESULTS Valid responses were obtained from 131(37.4%) [HIC: 71; LIC: 60] of contacted CeD experts from 63 countries. Compared with HIC, LIC experts perceived worse availability (HIC:80% vs LIC: 47%; P < 0.001), quality (52% vs 20%; P < 0.001), and legislation for labeling of GF foods (82% vs 37%; P < 0.001), with unfavorable reimbursement policies (27% vs 12%; P = 0.002), subsidies (32% vs 13%; P < 0.001), and insurance (76% vs 43%; P < 0.001) for CeD patients. LIC also lacked awareness about CeD among general physicians (69% vs 32%; P < 0.001), trained celiac dieticians (39% vs 12%; P = 0.002), and active CeD patient support groups (93% vs 50%; P < 0.001). All experts believed that GF foods were costly (94% vs 87%), frequently contaminated (27% vs 32%), and unfavorably taxed (97% and 93%). The experts agreed on key unmet needs and better research funding. Overall CeD preparedness score (median 58.3 vs 33.0; P < 0.001) was also associated with income. CONCLUSIONS The present survey highlights the opinion of global experts on the challenges, opportunities, and preparedness related to CeD and differences worldwide by income.
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Affiliation(s)
- Samagra Agarwal
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Shubham Prasad
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Agarwal
- Department of Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Raja A Raja Ali
- School of Medical and Life Sciences, Sunway University, Subang Jaya, Selangor, Malaysia
| | - Daniel A Leffler
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Peter H R Green
- Celiac Disease Center, Phyllis and Ivan Seidenberg Professor of Medicine, Columbia University, New York, New York, USA
| | | | - Robert P Anderson
- Wesley Medical Research - The Wesley Hospital, Brisbane, Queensland, Australia
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Chris J J Mulder
- Department of Gastroenterology, VU Medical Centre, Amsterdam, The Netherlands
| | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
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Shiha MG, Hadjisavvas N, Sanders DS, Penny HA. Optimising the Diagnosis of Adult Coeliac Disease: Current Evidence and Future Directions. Br J Hosp Med (Lond) 2024; 85:1-21. [PMID: 39347683 DOI: 10.12968/hmed.2024.0362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Coeliac disease is a common autoimmune disorder that affects nearly 1% of the general population. Current diagnostic strategies involve active case finding, serological tests, and endoscopy with biopsies. However, many patients with coeliac disease remain undiagnosed due to a wide gap between clinical guidelines and real-world practice in the diagnosis of adult coeliac disease. This highlights the need for increased education, training, and targeted quality-improvement interventions to optimise the diagnosis of coeliac disease.
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Affiliation(s)
- Mohamed G Shiha
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | | | - David S Sanders
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Hugo A Penny
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
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Riznik P, Carnohorski I, Dolinsek J, Dragutinovic N, Gyimesi J, Hauer AC, Klemenak M, Korponay-Szabo IR, Krencnik T, Masic M, Misak Z, Pavkov V, Popp A, Raba T, Szitanyi P, Dolinsek J. Uncovering the gap: Coeliac disease knowledge among healthcare professionals in the Danube region. BMC Gastroenterol 2024; 24:254. [PMID: 39123100 PMCID: PMC11312701 DOI: 10.1186/s12876-024-03349-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 08/05/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Several studies have shown that the knowledge about coeliac disease (CD) is not satisfactory among healthcare professionals (HCP). The aim of our study was to assess the knowledge of HCPs about CD in the Danube region. METHODS HCPs from 8 countries in the Danube region were asked to complete the web-based questionnaire about CD. Scores of HCPs were compared according to their speciality, work experience and country of residence. The results were compared with the results of a similar study conducted in Central Europe within the Focus IN CD project in 2016. RESULTS Questionnaire was completed by 799 HCPs from Austria, Croatia, Czech Republic, Hungary, Moldova, Romania, Serbia, and Slovenia. Mean score achieved by HCPs was 52.2%. Paediatric gastroenterologists scored the highest (75.3%). Comparing the data with the study conducted in Central Europe in 2016, we found a significant rise (p < 0.001) in the knowledge of paediatric gastroenterologists. Also, HCPs who previously took part in the Focus IN CD project, achieved higher score (61.1% vs. 50.8%; p < 0.001). CONCLUSION The knowledge about CD among HCPs in Danube region is not satisfactory. There has been a significant increase in the knowledge of paediatric gastroenterologists, showing the benefit of various awareness raising activities that were carried out recently.
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Affiliation(s)
- Petra Riznik
- Paediatric Department, Gastroenterology, Hepatology and Nutrition Unit, University Medical Centre Maribor, Maribor, Slovenia.
| | | | - Jasmina Dolinsek
- Municipality of Maribor, Project development office, Maribor, Slovenia
| | - Natasa Dragutinovic
- Department of Gastroenterology, Hepatology and Nutritional Disorders, University Children's Hospital, Belgrade, Serbia
| | - Judit Gyimesi
- Coeliac Disease Centre, Heim Pal National Paediatric Institute, Budapest, Hungary
| | - Almuthe Christine Hauer
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Martina Klemenak
- Paediatric Department, Gastroenterology, Hepatology and Nutrition Unit, University Medical Centre Maribor, Maribor, Slovenia
| | - Ilma Rita Korponay-Szabo
- Coeliac Disease Centre, Heim Pal National Paediatric Institute, Budapest, Hungary
- Medical Faculty, Department of Paediatrics, Coeliac Disease Study Group, University of Debrecen, Debrecen, Hungary
| | - Tomaz Krencnik
- Paediatric Department, Gastroenterology, Hepatology and Nutrition Unit, University Medical Centre Maribor, Maribor, Slovenia
| | - Mario Masic
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
| | - Zrinjka Misak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
| | | | - Alina Popp
- Department of Paediatrics, University of Medicine and Pharmacy and National Institute for Mother and Child Health Alessandrescu-Rusescu, Bucharest, Romania
| | - Tatiana Raba
- Paediatric Department, "Nicolae Testemitanu" State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | - Peter Szitanyi
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Jernej Dolinsek
- Paediatric Department, Gastroenterology, Hepatology and Nutrition Unit, University Medical Centre Maribor, Maribor, Slovenia
- Faculty of Medicine, Paediatric Department, University of Maribor, Maribor, Slovenia
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Crespo-Escobar P, Vázquez-Polo M, van der Hofstadt M, Nuñez C, Montoro-Huguet MA, Churruca I, Simón E. Knowledge Gaps in Gluten-Free Diet Awareness among Patients and Healthcare Professionals: A Call for Enhanced Nutritional Education. Nutrients 2024; 16:2512. [PMID: 39125392 PMCID: PMC11314127 DOI: 10.3390/nu16152512] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Diet is the only treatment for celiac disease (CeD), and good adherence to a gluten-free diet (GFD) is the only way to ensure complete remission and to prevent complications. Limited education about the disease and a GFD is an attributing factor to inadequate adherence. Thus, our aim was to assess the current knowledge about a GFD and the clinical monitoring of adherence to the diet among CeD people and HCPs. Specific questionnaires were designed and distributed to assess the knowledge of CeD people (Q1 questionnaire) (n = 2437) and to analyze the follow-up of the disease from the perspective of patients (Q2 questionnaire) (n = 1294) and HCPs (Q3 questionnaire) (n = 346). Two-thirds of HCPs specialized in pediatric care, while one-third did so in adult care. In CeD people, general questions regarding food classification and cross-contamination are well understood. When patients have doubts, 51.4% reported using the Internet and social networks. Thus, it is crucial that resources like social media are reliable and provide valuable information. Q3 revealed the lack of time to follow up the diet after diagnosis (48% of HCPs allocate < 15 min), the interest in further training, and the need for a professional specialized in diets within the healthcare system. In conclusion, it is essential to enhance nutritional education to increase awareness of a GFD.
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Affiliation(s)
- Paula Crespo-Escobar
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain;
- Department of Nutrition and Obesity, Hospital Recoletas Campo Grande, 47007 Valladolid, Spain
| | - Maialen Vázquez-Polo
- GLUTEN3S Research Group, Department of Nutrition and Food Science, University of the Basque Country, UPV/EHU, 01006 Vitoria-Gasteiz, Spain;
| | - Maria van der Hofstadt
- ALINUA, Food and Nutrition Cabinet Health Science Faculty, University of Alicante, UA, 03690 Alicante, Spain;
| | - Concepción Nuñez
- Laboratorio de Investigación en Genética de Enfermedades Complejas, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain;
| | - Miguel A. Montoro-Huguet
- Gastroenterology, Hepatology and Nutrition Unit, University Hospital San Jorge, 22004 Huesca, Spain;
- Department of Medicine, Faculty of Health and Sport Sciences, University of Zaragoza, 22002 Huesca, Spain
- Aragon Health Research Institute (IIS Aragon), 50009 Zaragoza, Spain
| | - Itziar Churruca
- GLUTEN3S Research Group, Department of Nutrition and Food Science, University of the Basque Country, UPV/EHU, 01006 Vitoria-Gasteiz, Spain;
| | - Edurne Simón
- GLUTEN3S Research Group, Department of Nutrition and Food Science, University of the Basque Country, UPV/EHU, 01006 Vitoria-Gasteiz, Spain;
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Hall S, Kenrick K, Day AS, Vernon-Roberts A. A Systematic Review of Tools to Assess Coeliac Disease-Related Knowledge. J Clin Med 2024; 13:4053. [PMID: 39064096 PMCID: PMC11277601 DOI: 10.3390/jcm13144053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/07/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Coeliac disease (CD) is an immune-mediated disorder, with dietary exclusion of gluten the only current treatment. A good knowledge of CD and gluten-free diet (GFD) is essential for those with CD to support effective self-management. Knowledge assessment with a validated tool helps evaluate understanding and knowledge gaps to better tailor educational resources. This study's aim was to perform a systematic review to identify validated CD knowledge assessment tools. Methods: PRISMA guidelines were followed, and searches were carried out in five literature databases. Papers were reviewed for tool development and testing process and assessed against pre-defined criteria for feasibility, validity, and reliability. Results: Twenty-five papers were included in the final analysis. Studies were from 16 countries, with a range of target populations, study designs, and development processes. Eleven reported pilot testing, and five assessed readability. Content validity was assessed in ten papers and formal content validity testing in one. Many tools contained items affecting generalisability outside the region developed. Conclusions: For a CD knowledge assessment tool to be suitable for use, it needs to be well designed, tested, and generalisable. No papers identified satisfied all requirements, thus highlighting a need to develop an appropriate tool.
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Affiliation(s)
- Sophie Hall
- Department of Paediatrics, University of Otago Christchurch, 4 Oxford Terrace, Christchurch 8011, New Zealand; (S.H.)
- Department of Paediatrics, Christchurch Hospital, 2 Riccarton Ave, Christchurch 8011, New Zealand
| | - Kristin Kenrick
- Department of General Practice and Rural Health, Dunedin School of Medicine, Rm 124, 55 Hanover Street, Dunedin 9016, New Zealand
| | - Andrew S. Day
- Department of Paediatrics, University of Otago Christchurch, 4 Oxford Terrace, Christchurch 8011, New Zealand; (S.H.)
- Department of Paediatrics, Christchurch Hospital, 2 Riccarton Ave, Christchurch 8011, New Zealand
| | - Angharad Vernon-Roberts
- Department of Paediatrics, University of Otago Christchurch, 4 Oxford Terrace, Christchurch 8011, New Zealand; (S.H.)
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Ageely H, Alfaifi SM, Abusageah F, Zogel B, Alsharif S, Tawhari M, Hamdi S, Abutalib Y, Althurwi S, Zaalah L, Moafa H, Hobani AH, Someili AM, Kariri AM. Knowledge of Health Students Regarding Nutritional Deficiencies in Patients With Celiac Disease in Jazan Region: A Cross-Sectional Study. Cureus 2024; 16:e62558. [PMID: 39027792 PMCID: PMC11254512 DOI: 10.7759/cureus.62558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
INTRODUCTION In Saudi Arabia, the prevalence of celiac disease (CeD) was 2.7% greater than the global pooled prevalence of 1.4%. Patients who strictly adhere to a lifetime gluten-free diet (GFD) may develop nutritional deficiencies potentially contributing to obesity, increased cardiovascular risk, and lower bone density. Therefore, this study aims to assess the knowledge of health students in the Jazan region regarding nutritional deficiencies in patients with CeD who are on a GFD and to determine the associated socio-demographic factors. METHODS A descriptive cross-sectional study was conducted among health college students of Jazan University, including students from the College of Medicine, Pharmacy, Nursing, Dentistry, Public Health and Health Informatics, and Allied Health Sciences, aged 18 and above, excluding internship students, students who did not complete the survey, and those who refused to participate. The minimum calculated sample size was 368. The questionnaire was adopted from the literature and translated into Arabic. It contained a socio-demographic section and a knowledge section that included 12 questions focusing on the content of macro- and micronutrients in a GFD and the impact of the diet on the health of patients with CeD. RESULTS The study included 369 participants, with 235 (64%) aged 17-22, 280 (76%) being females, and 341 (92%) being single. The College of Medicine and the College of Applied Medical Sciences had the highest representation, and the College of Dentistry was the lowest. Most participants were in the fourth year (30%) and sixth year (24%). The grade point average (GPA) had a median of 4.3. Approximately 59.1% were aware of nutritional deficiencies among CeD patients. None of the sociodemographic factors were associated with health students' knowledge regarding CeD. Participants from the College of Pharmacy had a lower knowledge of CeD nutrient deficiencies than those from the College of Medicine. (OR: 0.45, 95% CI: 0.22, 0.90). Most students stated that CeD patients should be advised to take multivitamin drugs and vitamin D supplements. Most acknowledged vitamin D, vitamin B12, and folic acid deficiencies in CeD patients. Similarly, most were aware of iron and calcium deficiencies, with a small percentage aware of zinc and copper. CONCLUSION Approximately 59.1% had an acceptable level of knowledge, which is considered a low knowledge level among students who will be future physicians and healthcare workers to whom CeD will represent the first-line disease exposed to. Rising knowledge and awareness among those students will guarantee correct diagnosis, treatment, and better outcomes among CeD patients, thus decreasing the disease burden and increasing the quality of those patients.
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Affiliation(s)
- Hussein Ageely
- Internal Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | | | | | - Basem Zogel
- Medicine and Surgery, Jazan University, Jazan, SAU
| | | | | | | | | | | | | | - Hassan Moafa
- Tropical Medicine, College of Public Health and Tropical Medicine, Jazan University, Jazan, SAU
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Bozorg SR, Lee AR, Mårild K, Murray JA. The Economic Iceberg of Celiac Disease: More Than the Cost of Gluten-Free Food. Gastroenterology 2024; 167:172-182. [PMID: 38670283 DOI: 10.1053/j.gastro.2024.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/28/2024]
Abstract
Celiac disease (CeD) is a chronic autoimmune disorder of global relevance, with the potential for acute and long-term complications. However, the economic burden of CeD is rarely considered and largely thought of as limited to the cost of gluten-free food. Fortunately, recent research has shed light on the various societal costs of CeD across the health care continuum. This article summarizes the current evidence on the economic impacts of CeD, which suggest that the societal economic burden of CeD stretches beyond the cost of gluten-free food. This review provides ample evidence of larger but hidden costs related to excess health care use for complications and comorbidities, as well as reduced productivity. Although significant advances are expected in the management of CeD, their effect on the economic burden of CeD remain uncertain. The aim of this review was to inform stakeholders across society and contribute to improved policies to support patients with CeD.
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Affiliation(s)
- Soran R Bozorg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Division of Gastroenterology, Karolinska University Hospital, Solna, Sweden.
| | - Anne R Lee
- Celiac Disease Center, Columbia University Medical Center, New York, New York
| | - Karl Mårild
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden; Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden
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Khan AS, Albaqshi BM, Alismael AM, Bohamad AH, Almutawah AA, Alabdellah AH, Almajed AS, Almajed AS, Almajed AS. The Role of Physicians' Factors in Underdiagnosis of Celiac Disease in the Eastern Province of Saudi Arabia. Cureus 2023; 15:e44690. [PMID: 37809243 PMCID: PMC10551662 DOI: 10.7759/cureus.44690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background Celiac disease is an autoimmune disorder triggered by gluten and related prolamines, which can cause a variety of symptoms and complications if left untreated. Despite being a common lifelong disorder, it often goes undiagnosed for a long time, leading to negative impacts on patients' health and quality of life. The diagnosis of celiac disease requires the presence of celiac-specific autoantibodies and distinctive histological changes in the small intestinal mucosa. Lack of disease knowledge among healthcare professionals and patients' adherence to gluten-free diets may contribute to diagnostic delays. Objectives This study aims to assess the reasons for celiac disease underdiagnosis and identify the functional deficiencies of healthcare professionals in the diagnosis and treatment of celiac disease, particularly in the Saudi population. Materials and methods A cross-sectional, questionnaire-based study was conducted among physicians in the Eastern Province of Saudi Arabia during the year 2023, between May and July. Participants were asked to complete an online self-administered questionnaire that included questions about their demographic characteristics, professional experience, and knowledge and attitudes toward celiac disease. The study recruited gastroenterologists, gastroenterology fellows, internal and family medicine specialists, residents, and general practitioners working in private or public health centers in various cities of the Eastern Province. Results The data were collected from 180 physicians who fulfilled the inclusion criteria of the study, with most participants aged under 30 years and predominantly male. Family medicine and general practitioners were the most represented specialties. While 49.4% of physicians knew that adult celiac disease was rare, only 19.4% frequently recommended celiac disease serology to their patients. In terms of risk, most physicians knew that adult celiac disease was a moderately severe and disabling disease, but only 24.4% thought that the cancer risk in patients with celiac disease was moderate. About 75.6% of physicians had an overall poor knowledge level regarding celiac disease, with gastroenterologists and internal medicine specialists demonstrating better knowledge compared to other specialties (P = 0.001). Conclusion The study found that a majority of physicians in the Eastern Province of Saudi Arabia had poor knowledge about celiac disease. This lack of knowledge could have implications for patient care, as it could lead to delays in diagnosis, inadequate treatment, and increased risk of complications.
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Affiliation(s)
- Abdul Sattar Khan
- Family and Community Medicine Department, King Faisal University, Al-Ahsa, SAU
| | - Baqer M Albaqshi
- Family and Community Medicine Department, King Faisal University, Al-Ahsa, SAU
| | - Ali M Alismael
- Family and Community Medicine Department, King Faisal University, Al-Ahsa, SAU
| | | | - Ahmed A Almutawah
- Family and Community Medicine Department, King Faisal University, Al-Ahsa, SAU
| | - Ali H Alabdellah
- Family and Community Medicine Department, King Faisal University, Al-Ahsa, SAU
| | - Alhwraa S Almajed
- Family and Community Medicine Department, King Faisal University, Al-Ahsa, SAU
| | - Abdullah S Almajed
- Family and Community Medicine Department, King Faisal University, Al-Ahsa, SAU
| | - Adnan S Almajed
- Family and Community Medicine Department, King Faisal University, Al-Ahsa, SAU
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AKARSU ORUNÇ E, ARSLAN M. EVALUATION OF KNOWLEDGE, ATTITUDES, AND PRACTICES OF COMMUNITY PHARMACISTS TOWARD CELIAC DISEASE. ANKARA UNIVERSITESI ECZACILIK FAKULTESI DERGISI 2023; 47:23-23. [DOI: 10.33483/jfpau.1330731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
Objective: The knowledge and attitude of pharmacists play an essential role in the patient counseling services of pharmacists. Celiac disease is one of the diseases in which patient follow-up and counseling are essential, and the number of studies dealing with the roles of pharmacists in this disease is very limited. This study aims to fill this gap and contribute to public health by evaluating community pharmacists' knowledge, attitudes, and practices for celiac disease.
Material and Method: Based on the literature, a measurement tool including the knowledge, attitudes, and practices of community pharmacists for celiac disease has been developed. The measurement tool was applied online to community pharmacists in Türkiye in 2021. The obtained data were subjected to explanatory factor analysis (EFA).
Result and Discussion: The number of pharmacists participating in this study is 408. A four-factor structure was obtained: knowledge of celiac disease, attitude towards celiac disease, counseling practices for celiac patients, and professional development practices. The Cronbach's alpha values of the factors were calculated between 0.794 and 0.935, which shows high reliability. These factors explained 70.343% of the total variance. The community pharmacists had positive attitudes toward counseling for celiac disease. Still, there were some deficiencies in terms of knowledge and practice. It is thought that the knowledge and awareness of pharmacists on celiac diseases can be increased by including issues related to celiac disease in both undergraduate education and vocational training programs.
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Affiliation(s)
| | - Miray ARSLAN
- VAN YÜZÜNCÜ YIL ÜNİVERSİTESİ, ECZACILIK FAKÜLTESİ, ECZACILIK MESLEK BİLİMLERİ BÖLÜMÜ, ECZACILIK İŞLETMECİLİĞİ ANABİLİM DALI
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Vázquez-Polo M, Navarro V, Larretxi I, Perez-Junkera G, Lasa A, Matias S, Simon E, Churruca I. Uncovering the Concerns and Needs of Individuals with Celiac Disease: A Cross-Sectional Study. Nutrients 2023; 15:3681. [PMID: 37686713 PMCID: PMC10490089 DOI: 10.3390/nu15173681] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
The treatment for celiac disease (CD) involves a strict gluten-free diet, which can be challenging and lead to questions for patients. Pinpointing these uncertainties can enable the creation of efficient educational resources. In this study, a questionnaire was specifically designed to gain insights into the knowledge, concerns, and needs of individuals with CD and their supporters. The questionnaire was distributed through the Instagram social network and received adequate responses from 300 participants, 258 (86%) being female and 152 (50.7%) falling in the age range of 25-44 years. The concerns of individuals with celiac disease and celiac supporters were rated on a 1-4 scale, with a mean score of 3.5 indicating significant concern. A total of 255 (85%) of all participants expressed that their principal concern was the social limitations they faced, such as difficulties in eating out and sharing food with others. Every participant evaluated their overall disease knowledge, averaging at 2.92 out of 4, indicating a reasonable level of awareness. When asked if they believed that improving general knowledge about CD in the general population would enhance their quality of life, the vast majority responded affirmatively. This finding underscores the importance of not only educating individuals with CD but also reaching out to the wider population, especially those who have a direct impact on the daily lives of individuals with CD, such as family members, friends, and food service providers.
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Affiliation(s)
- Maialen Vázquez-Polo
- Gluten 3S Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain; (M.V.-P.); (I.L.); (G.P.-J.); (A.L.); (S.M.); (E.S.); (I.C.)
- Bioaraba, Nutrition and Food Safety Group, 01009 Vitoria-Gasteiz, Spain
| | - Virginia Navarro
- Gluten 3S Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain; (M.V.-P.); (I.L.); (G.P.-J.); (A.L.); (S.M.); (E.S.); (I.C.)
- Bioaraba, Nutrition and Food Safety Group, 01009 Vitoria-Gasteiz, Spain
| | - Idoia Larretxi
- Gluten 3S Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain; (M.V.-P.); (I.L.); (G.P.-J.); (A.L.); (S.M.); (E.S.); (I.C.)
- Bioaraba, Nutrition and Food Safety Group, 01009 Vitoria-Gasteiz, Spain
- Centro Integral de Atención a Mayores San Prudencio, 01006 Vitoria-Gasteiz, Spain
| | - Gesala Perez-Junkera
- Gluten 3S Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain; (M.V.-P.); (I.L.); (G.P.-J.); (A.L.); (S.M.); (E.S.); (I.C.)
- Bioaraba, Nutrition and Food Safety Group, 01009 Vitoria-Gasteiz, Spain
| | - Arrate Lasa
- Gluten 3S Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain; (M.V.-P.); (I.L.); (G.P.-J.); (A.L.); (S.M.); (E.S.); (I.C.)
- Bioaraba, Nutrition and Food Safety Group, 01009 Vitoria-Gasteiz, Spain
| | - Silvia Matias
- Gluten 3S Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain; (M.V.-P.); (I.L.); (G.P.-J.); (A.L.); (S.M.); (E.S.); (I.C.)
- Bioaraba, Nutrition and Food Safety Group, 01009 Vitoria-Gasteiz, Spain
| | - Edurne Simon
- Gluten 3S Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain; (M.V.-P.); (I.L.); (G.P.-J.); (A.L.); (S.M.); (E.S.); (I.C.)
- Bioaraba, Nutrition and Food Safety Group, 01009 Vitoria-Gasteiz, Spain
| | - Itziar Churruca
- Gluten 3S Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain; (M.V.-P.); (I.L.); (G.P.-J.); (A.L.); (S.M.); (E.S.); (I.C.)
- Bioaraba, Nutrition and Food Safety Group, 01009 Vitoria-Gasteiz, Spain
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Majsiak E, Choina M, Cukrowska B. The Opinion of Polish Coeliac Patients on the Knowledge of Medical Professionals and Support Groups about Coeliac Disease-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3990. [PMID: 36900999 PMCID: PMC10001445 DOI: 10.3390/ijerph20053990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/11/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
A high quality of knowledge and how it is communicated by healthcare professionals (HCPs) let the patient understand coeliac disease (CD) and result in better adherence to therapeutic recommendations. Therefore, the aim of the current study was to assess the opinion of Polish respondents with CD on the comprehension of CD among Polish HCPs. The analysis was based on 796 responses from patients (the members of the Polish Coeliac Society) with confirmed CD diagnosis (224; 28.1% children and 572; 71.9% adults). The most frequently consulted HCPs regarding CD symptoms in the analysed group were gastroenterologists, and various support groups and associations for CD patients. Furthermore, their comprehension of CD was rated best, as 89.3% (n = 552) of the patients who had contact with support groups and associations classified their knowledge on CD as good. More than a half of the respondents (n = 310, 56.6%) who had contact with general practitioners (GPs) due to their symptoms, rated the doctor's knowledge on CD as bad. Nurses' comprehension on CD was classified as bad by 45 (52.3%) respondents who had contact with a nurse. Out of 294 Polish patients with CD who had contact with a dietician, 247 (84.0%) assessed that the dietician communicated their knowledge on CD well. The respondents rated that GPs and nurses communicated their knowledge on CD in the worst manner (60.4% and 58.1%, respectively). Out of 796 respondents, 792 (99.5%) provided information about the number of appointments with GPs due to symptoms that occurred prior to CD diagnosis. The respondents had contact with GPs 13 863 times before obtaining a CD diagnosis due to their symptoms. After the establishment of a CD diagnosis, the number of appointments with GPs decreased to 3850, and the average number of appointments decreased from 17.8 to 5.1. The respondents assessed that the knowledge on CD of HCPs is not satisfactory. The work of support groups and associations on CD, who promote reliable CD diagnosis and treatment methods, should be promoted. The cooperation between various HCPs needs to be encouraged, which may lead to better compliance.
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Affiliation(s)
- Emilia Majsiak
- Department of Basic Nursing, Chair of Development in Nursing, Faculty of Health Promotion, Medical University, Staszica 4/6, 20-081 Lublin, Poland
| | - Magdalena Choina
- Polish-Ukrainian Foundation of Medicine Development, Nałęczowska 14, 20-701 Lublin, Poland
| | - Bożena Cukrowska
- Department of Pathomorphology, The Children’s Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730 Warsaw, Poland
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Point-of-Care Screening for Coeliac Disease in Schoolchildren Reveals Higher Disease Prevalence in Croatia. Healthcare (Basel) 2022; 11:healthcare11010064. [PMID: 36611524 PMCID: PMC9819334 DOI: 10.3390/healthcare11010064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Coeliac disease (CD) is an immune-mediated inflammatory disease triggered by dietary gluten and related proteins in genetically predisposed individuals. Point-of-care (POC) methods are non-invasive and easily performed tests, which could help to reduce the diagnostic delay of CD. The aim of our study was to determine the prevalence of CD using rapid POC test in first-grade schoolchildren in Zagreb, Croatia. A rapid qualitative immunoassay POC test designed for detection of immunoglobulin (Ig) A and IgG deamidated gliadin antibodies (DGP), as well as total IgA (to identify IgA deficient patients) in whole blood, was used to test healthy children on gluten containing diet. Out of 1404 tested children (51% female), 85 (6.05%) had a positive rapid POC test result and were referred to paediatric gastroenterologist. Finally, 7 children were diagnosed with CD (0.5%). There was no significant difference in children with CD and children with positive POC but negative serology in sex, BMI, or symptoms. However, children diagnosed with CD complained of abdominal pain significantly more often. The prevalence of CD in first-grade schoolchildren was 1:200 (0.5%), higher than in previous studies performed in Croatia. The results imply the possible benefit of IgA and IgG DGP-based POC tests in population screening.
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Sahin Y, Sevinc E, Bayrak NA, Varol FI, Akbulut UE, Bükülmez A. Knowledge regarding celiac disease among healthcare professionals, patients and their caregivers in Turkey. World J Gastrointest Pathophysiol 2022; 13:178-185. [PMID: 36532302 PMCID: PMC9752282 DOI: 10.4291/wjgp.v13.i6.178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/22/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Celiac disease (CD) is one of the most prevalent chronic disorders. The clinical manifestations of CD are diverse and may present with gastrointestinal findings, extra-intestinal findings or no symptoms. Although there has been a marked increase in the prevalence of CD in the past 30 years, up to 95% of patients with CD remain undiagnosed. As most cases have atypical signs or no symptoms, the diagnosis of CD is either missed or delayed. In addition, one of the most important reasons for the delay in diagnosis may be the poor knowledge of healthcare professionals (HCPs) regarding CD. AIM To evaluate the knowledge of HCPs, patients and their caregivers (parents) regarding CD. METHODS The current study was carried out between June 2021 and February 2022 prospectively, as part of the Focus IN CD project. Patients with CD and their caregivers participated in the study from 6 different cities in Turkey. General practitioners, pediatricians, pediatricians with other subspecialities and pediatric gastroenterologists from different cities participated in the study. RESULTS The questionnaire was completed by 348 HCPs, 34 patients with CD, and 102 mothers and 34 fathers of patients with CD. Most of the participants were general practitioners (37.07%). There were 89 (25.57%) pediatricians and 72 (20.69%) pediatric gastroenterologists in the study. The highest score in all categories was achieved by pediatric gastroenterologists. There were significant differences between the four groups of HCPs in terms of the subsections of overall mean score, epidemiology and clinical presentation, treatment and follow-up. No significant difference was found between the groups (patients with CD, mothers of patients with CD and fathers of patients with CD) in terms of the questionnaire subsections. CONCLUSION The level of knowledge on CD among HCPs, patients and their caregivers was unsatisfactory. We consider that it is necessary to increase awareness and to develop e-learning activities on CD among HCPs, patients and their caregivers. Consequently, they may benefit from e-learning programs similar to the one created as part of the EU-funded project Focus IN CD (https://www.celiacfacts.eu/focusincd-en).
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Affiliation(s)
- Yasin Sahin
- Department of Pediatric Gastroenterology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
- Gaziantep Islam Science and Technology University, Faculty of Medicine, Gaziantep 27560, Gaziantep, Turkey
| | - Eylem Sevinc
- Department of Pediatric Gastroenterology, Karabuk University, Faculty of Medicine, Karabuk 78100, Karabuk, Turkey
| | - Nevzat Aykut Bayrak
- Department of Pediatric Gastroenterology, Zeynep Kamil Women and Children's Training and Research Hospital, University of Health Sciences, Istanbul 34668, Istanbul, Turkey
| | - Fatma Ilknur Varol
- Department of Pediatric Gastroenterology, Inonu University, Faculty of Medicine, Malatya 244280, Malatya, Turkey
| | - Ulas Emre Akbulut
- Department of Pediatric Gastroenterology, University of Health Sciences, Antalya Training and Research Hospital, Antalya 07100, Antalya, Turkey
| | - Ayşegül Bükülmez
- Department of Pediatric Gastroenterology, Afyonkarahisar Health Sciences University, Afyonkarahisar 03200, Afyonkarahisar, Turkey
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Characterization of Eosinophilic Esophagitis From the European Pediatric Eosinophilic Esophagitis Registry (pEEr) of ESPGHAN. J Pediatr Gastroenterol Nutr 2022; 75:325-333. [PMID: 35706095 DOI: 10.1097/mpg.0000000000003530] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Few pediatric data on phenotypic aspects of eosinophilic esophagitis (EoE) are available. The pEEr registry was developed to prospectively characterize children with EoE from Europe and Israel. METHODS pEEr is an ongoing prospective registry enrolling children with esophageal eosinophilia (≥15 eos/HPF). Anonymized data were collected from 19 pediatric centers. Data regarding demographics, clinical manifestations, endoscopy, histology, and therapies were collected. RESULTS A total of 582 subjects (61% male) were analyzed. The median age at diagnosis was 10.5 years [interquartile range (IQR): 5.7-17.7], whereas the age at symptom onset was 9.2 years (IQR: 4.3-16.4), resulting in a median diagnostic delay of 1.2 years (IQR: 0.7-2.3). The diagnostic delay was longer below age <6 years. Shorter diagnostic delays were associated with the presence of food allergy or a family history for EoE. Symptoms varied by age with dysphagia and food impaction more common in adolescents, while vomiting and failure to thrive more common in younger children ( P < 0.001). Among endoscopic findings, esophageal rings were more common in adolescents, whereas exudates were more frequent in younger children( P < 0.001). Patients who responded to proton pump inhibitors (PPIs) were more likely to be older, males, and less often presented severe endoscopic findings. Patients unresponsive to PPIs received topical steroids (40%), elimination diet (41%), or a combined therapy (19%). CONCLUSIONS EoE findings vary according to age in pediatric EoE. Young children are commonly characterized by non-specific symptoms, atopic dermatitis, food allergy, and inflammatory endoscopic lesions. Adolescents usually have dysphagia or food impaction, fibrostenotic lesions, and a better PPI response.
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Kozhakhmetova A, Aidossov S, Kapassova A, Borsoldayeva K. Current knowledge and "myths" about celiac disease among physicians in the Republic of Kazakhstan: A countrywide cross-sectional study. Front Public Health 2022; 10:956135. [PMID: 36033766 PMCID: PMC9411637 DOI: 10.3389/fpubh.2022.956135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/25/2022] [Indexed: 01/24/2023] Open
Abstract
Background Celiac disease (CD) is a common genetically predisposed autoimmune condition affecting the gut and other organs. Disease awareness is one of the key components of early case identification. This study aimed to assess awareness about CD among primary care physicians, who are the front-liners in suspecting the diagnosis, and other medical specialists. Methods and findings The questionnaire for this survey-based study was created based on the latest international guidelines on CD and included a consent form, 5 general questions (age, gender, etc.), and 10 specific questions concerning CD. Overall, 232 respondents from 13 country provinces (out of 14) and two republican cities were recruited for this study. Of them, 110 (47.4%) were primary care physicians and 122 (52.6%) other medical specialists, including 10 (4.3%) gastroenterologists. A scoring system was used to classify the level of awareness of participants into 3 categories, namely, poor, fair, and good. Analysis of responses revealed poor awareness in 59.4% of physicians, associated with work in republican/province/district/rural/village hospitals (p = 0.004), male gender (p = 0.006), and age of 40-50 years (p = 0.02). The most common "myths" about CD were the following: "symptoms are always obvious in children" or "in adults" (92.5 or 88.4% of respondents, respectively); "genetic mutation HLA DQ2/DQ8 causes the development of CD in all carriers of the mutation" (51.3%); "CD is a disease of children only" (12.5%); and "is triggered by dairy products" (8.6%). Genotyping of HLA DQ genes has been recommended in case of CD suspicion by every third respondent and was advocated as a "golden standard" confirmatory test by every fifth respondent. A quarter of respondents revealed their incorrect treatment strategies: gluten-free diet for 1 month, dairy-free diet, Helicobacter pylori eradication therapy, or responded that did not know how to treat. Overall, 93.5% of respondents expressed intention to learn more about CD, while the rest 6.5% thought that they knew enough, although their knowledge was poor. Conclusion This study revealed a poor level of awareness among physicians in Kazakhstan and identified common misconceptions about CD, which potentially could lead to incorrect application of diagnostic tests, delay in diagnosis, and inefficient treatment. Development and implementation of educational programs as well as promotion of self-learning would increase awareness and unravel misconceptions.
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Affiliation(s)
- Aizhan Kozhakhmetova
- Biology Department, School of Sciences and Humanities, Nazarbayev University, Nur-Sultan, Kazakhstan
| | | | - Aissulu Kapassova
- General Practice Department, Astana Medical University, Nur-Sultan, Kazakhstan
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Verma AK. Nutritional Deficiencies in Celiac Disease: Current Perspectives. Nutrients 2021; 13:nu13124476. [PMID: 34960029 PMCID: PMC8703793 DOI: 10.3390/nu13124476] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/07/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Anil K Verma
- Celiac Disease Research Laboratory, Department of Pediatrics, Università Politecnica delle Marche, 60123 Ancona, Italy
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Samasca G, Lerner A. Celiac disease in the COVID-19 pandemic. J Transl Autoimmun 2021; 4:100120. [PMID: 34485888 PMCID: PMC8406545 DOI: 10.1016/j.jtauto.2021.100120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/30/2021] [Indexed: 12/19/2022] Open
Abstract
Background The COVID-19 pandemic has had an impact on global health. Design The impact of the COVID-19 pandemic on patients with coeliac disease was assessed in the present review. Results The incidence of coeliac disease and the problems associated with coeliac disease increased during the COVID-19 pandemic. Adherence to the diet is crucial for the patient's health and quality of life since the only approved therapy for coeliac disease is a gluten withdrawal. Conclusions A gluten-free diet should be promoted by the therapeutic team and implemented among these categories of patients.
Health education to follow the GFD does not exist in many countries. Unfortunately, the COVID-19 pandemic has increased psychological problems among patients with CD. The association of T1D with CD has been and remains a problem in CD management. Associating IBD with CD is again a challenge. Psychological problems also appeared in the associations of CD with T1D and IBD. The COVID-19 virus did not pose an increased risk to CD patients, but the COVID-19 pandemic brought many psychological problems to CD patients. CD patients should adhere to GFD, in general, hence pay attention to gluten withdrawal during the COVID-19 pandemics, to avoid other complications and improve their QOL.
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Affiliation(s)
- Gabriel Samasca
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Aaron Lerner
- Chaim Sheba Medical Center, The Zabludowicz Research Center for Autoimmune Diseases, Tel Hashomer, 5262000, Israel
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Paul SP, Balakumar V, Gillett PM. Celiac Disease Management in the United Kingdom Specialist Pediatric Gastroenterology Centers-A Service Survey. J Pediatr Gastroenterol Nutr 2021; 72:e149-e153. [PMID: 33908736 DOI: 10.1097/mpg.0000000000003126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The 2012 European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines on celiac disease (CD) recommended a no-biopsy pathway (NBP) for symptomatic children with high immunoglobin A (IgA)-based anti-tissue transglutaminase (TGA-IgA) titers, positive anti-endomysial antibody and human leukocyte antigen (HLA)-DQ2/DQ8 status. We aimed to understand variations in practice amongst specialist pediatric gastroenterology centers (SPGIC) in the United Kingdom (UK). METHODS A survey questionnaire was sent to all UK SPGIC (n = 29) providing endoscopy services for CD diagnosis. It was divided into four main subgroups: analyzing diagnosis of CD through adherence to the ESPGHAN (2012) guidelines, post-diagnosis care and long-term follow-up and discharge from pediatric services. RESULTS All 29 responded. NBP was implemented in 28 of 29 centers. Five of 29 centers had already stopped HLA-DQ2/DQ8 testing for NBP diagnosis. Twenty six of 29 centers were performing endoscopy on screening-identified children (mostly asymptomatic, "at-risk" patients). Diagnosis was communicated by a doctor in 65% SPGIC (n = 19). Most centers (n = 23) waited 6-12 months post-diagnosis to start gluten-free oats. Routine vitamin D supplementation was commenced by 4 of 29 centers. All centers repeated TGA-IgA to assess normalization but at varying times post-GFD. Follow-up was with a combination of doctors/dieticians (n = 26). Eleven of 29 centers discharged their patient to primary care. CONCLUSIONS There was excellent uptake of ESPGHAN guidelines (2012) in the UK and adherence to guidelines is generally good. Despite published evidence and pragmatic advice from the British Society of Paediatric Gastroenterology Hepatology and Nutrition and National Institute for Health and Care Excellence, significant differences remain in diagnostic and ongoing management practice and are opportunities for research and directive evidence-based follow-up guidance.
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Affiliation(s)
- Siba Prosad Paul
- Department of Pediatrics, Yeovil District Hospital, Yeovil, United Kingdom
| | | | - Peter Michael Gillett
- Department of Pediatric Gastroenterology, Royal Hospital for Sick Children, Edinburgh, Scotland
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Dembiński Ł, Mazur A, Dąbrowski M, Jackowska T, Banaszkiewicz A. Knowledge of Medical Students and Medical Professionals Regarding Nutritional Deficiencies in Patients with Celiac Disease. Nutrients 2021; 13:1771. [PMID: 34067382 PMCID: PMC8224609 DOI: 10.3390/nu13061771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 12/11/2022] Open
Abstract
A gluten-free diet provides relief from symptoms for patients with celiac disease, although there is still a risk of nutritional deficiencies. These patients can potentially consume an excessive amount of fat and insufficient amounts of fiber, iron, vitamin D, and calcium. This study aimed to assess the knowledge of medical students and healthcare professionals in Poland regarding nutritional deficiencies and the prevention of such deficiencies in patients with celiac disease who are on a gluten-free diet. Of the 430 survey participants, 46% did not realize the risk of nutritional deficiencies in patients with celiac disease. The knowledge of the participants was lowest regarding the risk of being overweight or obese. Among the healthcare professionals, an acceptable level of correct answers was provided by only 37% of individuals and was highest for the dietitians' group. Our results demonstrate the need to improve the education of healthcare professionals concerning nutrition in patients with celiac disease.
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Affiliation(s)
- Łukasz Dembiński
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, 02-091 Warsaw, Poland; (Ł.D.); (A.B.)
| | - Artur Mazur
- College of Medical Sciences, University of Rzeszow, 35-310 Rzeszów, Poland;
| | - Mariusz Dąbrowski
- College of Medical Sciences, University of Rzeszow, 35-310 Rzeszów, Poland;
| | - Teresa Jackowska
- Department of Pediatrics, Center of Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Aleksandra Banaszkiewicz
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, 02-091 Warsaw, Poland; (Ł.D.); (A.B.)
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