[Celiac disease - a missed diagnosis].

BACKGROUND: In Czech population celiac disease is diagnosed infrequently and on the contrary frequently too late. AIM: The present quality of diagnostics, therapy, follow-up and relation of celiacs to causal therapy has been evaluated. METHODS: A structured questionnaire was offered to celiacs followed at different out-patient departments (medicine, gastroenterology, dermatology, hematology, and endocrinology) of one institution (Central Military Hospital Prague) in the years 2000-2010. The following topics were analyzed: the health care provided to probands before the diagnosis of celiac disease (number and speciality of involved physicians, symptoms and suggested conditions), methods of celiac disease diagnosis, screening of the disease in first degree relatives, compliance of gluten-free diet and its limiting factors. RESULTS: 102 (77.3%) out of 132 distributed questionnaires were evaluated. The diagnosis of celiac disease remains a late issue. 36.8% of celiac patients were diagnosed after a period of more than 10 years of symptoms. Diarrhea has been frequently combined with extraintestinal symptoms (anemia, decreased body mass, depression, and osteoporosis). Gluten-free diet is an expensive dietary regimen and its adherence brings various restrictions to celiacs in every-day life. CONCLUSION: The present state of celiac disease diagnostics and follow-up requires interdisciplinary cooperation and increased interest of health and social care institutions including their leading representatives.