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Does the introduction of a paediatric specialist coeliac clinic in the district general hospital improve adherence to bspghan guidelines for management of coeliac patients?
  1. L A Whyte,
  2. R Wasala,
  3. V Iyer,
  4. A J Mayne
  1. Paediatrics, Sandwell and West Birmingham NHS Trust, Birmingham, UK

Abstract

Background Coeliac disease is a common chronic condition in the paediatric population with a prevalence of 1:100 in the UK. It commonly occurs in isolation, but is known to be associated with other conditions such as diabetes and Down's syndrome. Without prompt diagnosis and management, coeliac disease has a variety of clinical manifestations, which can have significant consequences for growth and pubertal development. The recent publication of BSPHGAN guidelines on management of coeliac patients aims to address these issues.

Data collection Audit of the management of patients with coeliac disease in general paediatric clinics was performed in 2008. This identified 15 patients with coeliac disease, 13 had biopsy at diagnosis, 8 had annual TTG, 4 had been told about the coeliac society. Recommendation from this cycle was to set up an annual review clinic for all coeliac patients based on BSPHGAN guidelines, to be attended by paediatrician with a special interest in gastroenterology and dietician. A second audit cycle performed in 2010.

Findings Following introduction of the new coeliac clinic which runs four times per year, a total of 31 patients are now being followed-up. None of these patients have other chronic illnesses (diabetes/Down's syndrome), as these patients continue to be seen in their own specialist clinics. Of the 31 patients, all are being reviewed annually, with annual TTGs and growth assessments by both a paediatrician and dietician. 29 (93%) had symptoms recorded, 62% (19) had adherence to gluten free diet recorded. 22 (71%) had biopsy confirmation at diagnosis.

Recommendations Introduction of a specialist coeliac clinic in the district general hospital improves adherence to BSPHGAN guidelines on management of coeliac disease. It improves self empowerment to manage their own condition through access to specialist information provided by dieticians and paediatricians with special interest in coeliac disease and by receiving information about the coeliac society.

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