{
  "abstract": "Introduction The estimated global prevalence of coeliac disease (CD) is 1.4%, with evidence suggesting comparable prevalence across the Indian subcontinent. 1 Despite documented cases there are no data highlighting prevalence in Sri Lanka (SL). Increasing regional recognition, diet westernisation and rising wheat exposure suggest that disease burden in SL may be under-recognised. We compared clinician awareness, attitudes and access to diagnostic resources for CD in SL and the UK to assess whether structural constraints contribute to underdiagnosis.Methods A novel electronic survey was distributed to clinicians in SL and the UK through professional networks using snowball sampling. It assessed self-rated knowledge, guideline awareness, diagnostic confidence, screening practices and access to services. Comparisons were performed using Chi-squared testing for categorical variables and Mann–Whitney U test for ordinal responses. Free-text responses were analysed using structured content analysis.Results UK clinicians (n=54; 76% gastroenterologists) reported greater awareness in CD than SL clinicians (n=102; 58% nutrition physicians/gastroenterologists). Good or excellent knowledge was reported by 79.6% of UK respondents versus 38.2% in SL (p<0.001), with similar differences in guideline awareness (79.6% vs 44.1%, p<0.001). Confidence in guideline-based management was higher among UK clinicians (83.3% vs 59.8%, p=0.003).CD serology was spontaneously identified as a 1st line investigation by 40.7% of UK clinicians and by none in SL. However, access to serology differed between settings, with IgA tTG being available to 92.6% of UK respondents compared with 10.8% in SL.UK clinicians were more likely to routinely screen high-risk groups (44.4% vs 8.8%, p<0.001) and to consider CD in iron deficiency anaemia (79.6% vs 18.6%) or unexplained gastrointestinal symptoms (79.6% vs 28.4%, p<0.01).Despite these differences, perceived underdiagnosis was high in both settings (87.0% UK vs 78.4% SL). SL clinicians most frequently identified limited awareness (54.9%), restricted access to investigations (46.1%), absence of national guidelines and cost availability of gluten-free foods as barriers, whereas UK clinicians highlighted dietetic capacity, pathway delays and primary care awareness.Conclusions Clinicians in both countries recognise CD as underdiagnosed; in SL diagnostic behaviour is constrained by limited access to serological testing and supporting infrastructure. Interventions should prioritise affordable serological testing, locally adapted guidelines and education. These findings offer opportunities for collaboration, where groups such as the BSG International Committee could potentially support educational outreach to aid in training and improve access to diagnostics.Reference Makharia G, et al. Nat Rev Gastroenterol Hepatol. 2022;19(5):313–27.",
  "authors": [
    {
      "affiliations": [
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom"
      ],
      "name": "Alexander Lal"
    },
    {
      "affiliations": [
        "Medical Research Institute, Colombo, Sri Lanka"
      ],
      "name": "Thimathi Wickramasekara"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, National Hospital of Sri Lanka, Kandy, Sri Lanka"
      ],
      "name": "Nandana Dinamithra"
    },
    {
      "affiliations": [
        "Medical Nutrition Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka"
      ],
      "name": "Shalika Kurukulaarachchi"
    },
    {
      "affiliations": [
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom"
      ],
      "name": "Buddhini Samarsinghe"
    },
    {
      "affiliations": [
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom"
      ],
      "name": "Connor Cotton"
    },
    {
      "affiliations": [
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom",
        "Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, S10 2TN, Sheffield, United Kingdom"
      ],
      "name": "David Sanders"
    }
  ],
  "title": "P440 Coeliac disease in a resource-limited setting: a comparative study of Sri Lanka and the United Kingdom",
  "uid": "7529366a-4c83-565d-83a1-7bf906daf372"
}