Celiac Disease: Education, Barriers to Care, Dietary Recommendations, and Screening
Bibliographic record
Abstract
Introduction: After the diagnosis of celiac disease (CD) is made, there are varying levels of support provided to patients by their gastroenterologists. The prevalence of CD appears to be rising dramatically, and is suspected to affect nearly 3 million Americans. If left untreated, CD can cause a variety of complications ranging from iron deficiency to osteoporosis to small intestinal neoplasms. To gain a deeper understanding of gastroenterologists’ practices pertaining to CD, we examined physician-_provided patient education, identified barriers to care, discerned what dietary recommendations are made, established screening labs, and identified vaccination practices via physician completed survey. Methods: Gastroenterology physicians at Digestive Diseases Weekly in Chicago, IL (May 2014) were asked to complete a survey regarding their practices related to CD. Results: Seventy-eight gastroenterologists working in 5 continents were polled; 53% practice in the U.S. and Canada, and 86% were attending physicians. The number of CD patients (and % of MDs) seen on a monthly basis in clinic were: 1-9 (73%), 10-30 (22%), and >30% (5%), respectively. Lack of time, lack of compensation, and limitation in knowledge of gluten restricted products were cited as barriers to care 52.5%, 7.7%, and 24.4% of the time, respectively. The most frequent form of education provided by MDs was referrals to dietitians (64%) and nutritionists (36%). Some physicians also provided educational resources via the internet, various smartphone applications, and nutrition books. Approximately 54% of MDs provided direct recommendations on consumption of gluten-free products. A majority (91%) recommend strict adherence to a gluten-free diet, whereas only 2.5% recommend permissive gluten intake and 6% deferred to nutritionists. The 3 most commonly screened labs were iron studies (78%), vitamins A,D, E, B12 (82%), and folic acid (53.8%). Forty-four percent of gastroenterologists took primary responsibility to vaccinate their patients with pneumococcal polysaccharide vaccination. Conclusion: Treatment approaches for CD are highly dependent on the practicing gastroenterologist. Lack of time, compensation, and understanding of gluten-free products are major barriers in physiciandirected education. As a result, physicians are making the appropriate referrals to dietitians, nutritionists, and online resources to improve patient education. Despite variable symptomatic response to gluten restriction among CD patients, most physicians recommend life-long and strict gluten restriction. The majority of gastroenterologists are not vaccinating their patients, and instead, defer this responsibility to primary care physicians.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".