Diagnostic delay in adult coeliac disease: An Italian multicentre study

Lenti, Marco Vincenzo;Aronico, Nicola;Bianchi, Paola Ilaria;D'Agate, Carmela Cinzia;Neri, Matteo;Volta, Umberto;Mumolo, Maria Gloria;Astegiano, Marco;Calabrò, Antonino Salvatore;Zingone, Fabiana;Latella, Giovanni;Di Sario, Antonio;Carroccio, Antonio;Ciacci, Carolina;Luzza, Francesco;Bagnato, Carmela;Fantini, Massimo Claudio;Elli, Luca;Cammarota, Giovanni;Gasbarrini, Antonio;Portincasa, Piero;Latorre, Mario Andrea;Petrucci, Clarissa;Quatraccioni, Claudia;Iannelli, Chiara;Vecchione, Nicoletta;Rossi, Carlo Maria;Broglio, Giacomo;Ianiro, Gianluca;Marsilio, Ilaria;Bibbò, Stefano;Marinoni, Beatrice;Tomaselli, Donatella;Abenavoli, Ludovico;Pilia, Riccardo;Santacroce, Giovanni;Lynch, Erica;Carrieri, Antonella;Mansueto, Pasquale;Gabba, Margherita;Alunno, Giacomo;Rossi, Chiara;Onnis, Francesca;Efthymakis, Konstantinos;Cesaro, Nicola;Vernero, Marta;Baiano Svizzero, Federica;Semeraro, Francesco Paolo;Silano, Marco;Vanoli, Alessandro;Klersy, Catherine;Corazza, Gino Roberto;Di Sabatino, Antonio

2023-01-01

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Abstract

Background: There are few data regarding the diagnostic delay and its predisposing factors in coeliac disease (CD). Aims: To investigate the overall, the patient-dependant, and the physician-dependant diagnostic delays in CD. Methods: CD adult patients were retrospectively enroled at 19 Italian CD outpatient clinics (2011-2021). Overall, patient-dependant, and physician-dependant diagnostic delays were assessed. Extreme diagnostic, i.e., lying above the third quartile of our population, was also analysed. Multivariable regression models for factors affecting the delay were fitted. Results: Overall, 2362 CD patients (median age at diagnosis 38 years, IQR 27-46; M:F ratio=1:3) were included. The median overall diagnostic delay was 8 months (IQR 5-14), while patient- and physician-dependant delays were 3 (IQR 2-6) and 4 (IQR 2-6) months, respectively. Previous misdiagnosis was associated with greater physician-dependant (1.076, p = 0.005) and overall (0.659, p = 0.001) diagnostic delays. Neurological symptoms (odds ratio 2.311, p = 0.005) and a previous misdiagnosis (coefficient 9.807, p = 0.000) were associated with a greater extreme physician-dependant delay. Gastrointestinal symptoms (OR 1.880, p = 0.004), neurological symptoms (OR 2.313, p = 0.042), and previous misdiagnosis (OR 4.265, p = 0.000) were associated with increased extreme overall diagnostic delay. Conclusion: We identified some factors that hamper CD diagnosis. A proper screening strategy for CD should be implemented.