Unfortunately, not all physicians follow these guidelines, and a new study points to one possible reason. The study , performed by U.S.-based clinicians and published by the European Journal of Gastroenterology & Hepatology, used a large national database to identify all adults who had endoscopies and biopsies for celiac disease between 2006 and 2009. The researchers then analyzed those cases, which involved more than 92,000 people, to determine whether gastroenterologists who performed more endoscopies than the average tended to take fewer samples of the intestinal lining during each procedure. As it turned out, gastroenterologists with a higher procedure volume — in other words, who performed lots of endoscopies — did take fewer intestinal samples. Meanwhile, the study also found that gastroenterologists who worked more closely with other members of their medical specialty tended to take more samples, possibly because of peer-to-peer education. The authors note that most cases of celiac remain undiagnosed in the U.S., in part because too few physicians follow the guidelines calling for at least four samples of the intestinal lining. The moral of this story? If you’re undergoing celiac disease testing , try to choose a gastroenterologist who doesn’t perform tons of endoscopies, or one who works in concert with other gastroenterologists. And, stress during your pre-procedure visit that you expect the gastroenterologist to take at least four samples of your small intestine. Keep up with the latest in the celiac disease/gluten sensitivity world — sign up for my newsletter , connect with me on Facebook and Google+ , or follow me on Twitter – @AboutGlutenFree . Photo Getty Images/Rob Melnychuk
Many Gastroenterologists Unaware of Appropriate Immunizations for IBD Patients
According to the studies’ authors, many IBD patients are not being vaccinated appropriately. One thousand gastroenterologists, randomly selected from the membership of the American College of Gastroenterology, were asked to complete a 19-question electronic survey regarding suitable vaccines for the immune-competent and immunosupressed IBD patient and the barriers to recommending the vaccines. The researchers also assessed the perceived role of the gastroenterologist versus the PCP. The researchers analyzed 108 responses and found only 56 (52 percent) of the gastroenterologists took an immunization history most or all of the time. There was no significant difference between gastroenterologists with smaller practices (less than 40 IBD patients) compared with those with larger practices (greater than 40 IBD patients) in how often they asked their patients about immunization history. In contrast, more academic physicians (67.5 percent) asked their patients about immunization history most or all of the time compared to 42.4 percent of private physicians. Sixty-nine (64 percent) of the respondents thought the PCP was responsible for determining which vaccinations to administer to the IBD patient and ninety (83 percent) believed the PCP was responsible for administering the vaccine. Sixteen of the 108 surveyed gastroenterologists did not regularly recommend immunization against influenza. The most common reasons included “too busy/forgot,” “no specific reason,” and “did not know my patient needed it.” In addition, the researchers found 20 to 30 percent of gastroenterologists would erroneously recommend any of the three queried live, attenuated vaccines (MMR, herpes zoster, varicella) to their immune-suppressed IBD patient. In addition, 24 to 35 percent of gastroenterologists would incorrectly not give the three queried live, attenuated vaccinations to their immune-competent patients. Of the inactivated vaccines, knowledge regarding the HPV vaccine was particularly poor, with only 71 (66 percent) recommending the vaccine to their immune-competent patients and only 51 (47 percent) recommending the vaccine to their immune-suppressed patients). In general, gastroenterologists were more likely to make the correct vaccine recommendations for their immunocompetent IBD patients. “Gastroenterologist knowledge of the appropriate immunizations to recommend to the IBD patient is limited and may be the primary reason why the majority of gastroenterologists believe that the PCP should be responsible for vaccinations,” said primary author Sharmeel Wasan, MD, MSc, an assistant professor of medicine at BUSM and a gastroenterologist at BMC. Over the last five years, the problem of vaccine preventable illnesses in patients with IBD have been described, including case reports of fulminant hepatitis and fatal varicella.