A celiac disease (CeD) program improves quality care metrics and resolves symptoms like diarrhea among patients with CeD, according to study results published in Digestive Diseases and Sciences.
Patients with CeD often struggle with adherence to a gluten-free diet, affecting their quality of life and overall outcomes. Despite these obstacles, specialized multidisciplinary initiatives strive to enhance the quality of care and outcomes for these individuals, although their effectiveness is not yet fully comprehended.
To this aim, investigators conducted a retrospective cohort study including electronic health data from a tertiary care center and examined the frequency of achieving guideline-driven quality care metrics, symptom resolution, and serological response through immunoglobulin A anti-tissue transglutaminase levels. Patients were aged 18 years and older with CeD identified by the International Classification of Diseases, 10th revision, diagnostic codes.
Patients were divided into 2 groups: those who underwent treatment within the Cleveland Clinic’s specialized CeD program initiated in September 2019 and those who received conventional care outside the program. The study included only patients with confirmed CeD diagnosis through biopsy. For each patient in the CeD program, a conventional care patient was chosen randomly for comparison.
The final analysis included 340 patients, with 120 in the CeD program and 220 receiving conventional care. Overall, the majority of patients were women (75%) and 96.8% identified as White.
Examining conventional care patients categorized by diagnosis date (pre- and post-2019) revealed no statistically significant difference in celiac quality care metric frequency.
In contrast, CeD program patients showed significantly higher implementation rates of celiac care quality metrics compared with standard care, including referrals to a dietitian, medical follow-up, bone densitometry scans, hepatitis B testing, documented vaccine and family testing discussions, and follow-up serology.
In terms of symptom changes between cohorts, diarrhea was present in 43.6% CeD patients, being the most common symptom at diagnosis for both groups, with 82.6% resolving in the CeD program compared with 64.2% in standard care after starting a gluten-free diet (P =.025). Abdominal pain and atrophic glossitis symptoms markedly improved in CeD program patients compared with those receiving conventional care.
Both the CeD program and conventional care cohorts showed a 62.8% serological response rate, with no significant difference between them (P >.99).
Limitations include the retrospective design, the program’s relative youth, and lack of repeat biopsies to assess histologic response.
“It will be important to see if high quality metrics and improved outcomes reported in this single center study are reproducible in CD [CeD] programs elsewhere; a multicenter study would further inform this topic,” the investigators noted.
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