Quality Improvement in Gastroenterology Clinical Practice

Rakhi Kheraj; Sumeet K. Tewani; Gyanprakash Ketwaroo; Daniel A. Leffler


Clin Gastroenterol Hepatol. 2012;10(12):1305-1314. 

In This Article

Celiac Disease

Celiac disease is common, with a prevalence of 1% or more, and has many intestinal and extraintestinal manifestations.[88] In gastroenterology practice, QI efforts to address the growing celiac disease population should focus on adequate testing and monitoring. Endoscopy with small intestinal biopsy is the standard used to identify patients with celiac disease. However, the reliability of endoscopic biopsy analysis depends on the number of samples collected and the locations they were taken from; the recommended 6 biopsy samples are not regularly collected,[20] and newer recommendations for collecting samples from the duodenal bulb are often not considered.[89,90]

Practices may consider the following: (1) establishing guidelines for biopsy analysis of individuals with known or suspected celiac disease; (2) coordinating these guidelines with the pathology group; and (3) auditing records from patients who have undergone endoscopy for signs and symptoms of celiac disease to evaluate the proportion from whom adequate biopsies were taken; and (4) further interventions could be needed if gaps in practice are noted.

Celiac disease is a lifelong disorder that affects multiple body systems. Although management guidelines vary,[88] the standard of care includes patient visits to a celiac dietitian, monitoring levels of celiac-associated antibodies, and measuring bone density within the first year of diagnosis. Documentation of 1 or more of these recommendations could be used as a marker of the quality of overall care provided to patients with celiac disease. As with other disorders, it can be helpful to create practice guidelines based on local resources and patient populations, but their use should be regularly assessed and changes made as needed to improve rates of appropriate care.