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Open Access Research article

Interprovider variation of celiac disease testing in childhood chronic abdominal pain

Bruno Pedro Chumpitazi12*, Krupa Mysore1, Cynthia Man-Wai Tsai1 and Robert Jay Shulman123

Author Affiliations

1 Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA

2 Texas Children’s Hospital, 6701 Fannin Street, CCC 1010.03, Houston, TX, USA

3 ARS/USDA Children’s Nutrition Research Center, Houston, TX, USA

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BMC Gastroenterology 2013, 13:150  doi:10.1186/1471-230X-13-150

Published: 14 October 2013

Abstract

Background

To determine within one tertiary care center: 1) the variation between providers in testing for celiac disease in children with chronic abdominal pain; 2) the characteristics of those children who were more likely to be tested, and 3) the prevalence of celiac disease in those evaluated.

Methods

Retrospective review of children with a primary complaint of chronic abdominal pain referred to a tertiary care children’s hospital for pediatric gastroenterology evaluation over a 2-year period was conducted. Children with at least two visits and without an identified organic etiology for the pain were included.

Results

160 children were evaluated by 16 pediatric gastroenterologists and one nurse practitioner. Celiac serologic testing was completed in 63 (39.4%) children. There was no significant variance in the frequency of celiac serologic testing between providers. Child age, gender, body mass index, and baseline gastrointestinal symptoms did not predict whether celiac serologic testing occurred, though Caucasians (P < 0.01) were more likely to be tested. Eighty-two (51.3%) children underwent either serologic testing and/or esophagogastroduodenoscopy. Four (4.9%, 95% CI: 1.6-11.3%) of the 82 tested were diagnosed with celiac disease.

Conclusions

Though interprovider variation for celiac disease testing in children with chronic abdominal pain did not occur, a large number of these children were not evaluated for celiac disease. Children’s race/ethnicity but not their associated gastrointestinal symptoms predicted whether celiac testing was undertaken. In those tested, celiac disease was identified in a higher percentage than that expected in the general population.

Keywords:
Celiac disease; Children; Abdominal pain; Serology; Variation