Screening for celiac disease in the general population and in high‐risk groups

Abstract

Background: Celiac disease (CD) occurs in approximately 1% of the Western population. It is a lifelong disorder that is associated with impaired quality of life (QOL) and an excessive risk of comorbidity and death. Objectives: To review the literature on screening for CD in relation to the current World Health Organization (WHO) criteria for mass screening. Methods: We performed a PubMed search to identify indexed papers on CD screening with a publication date from 1900 until 1 June 2014. When we deemed an abstract relevant, we read the corresponding paper in detail. Results: CD fulfills several WHO criteria for mass screening (high prevalence, available treatment and difficult clinical detection), but it has not yet been established that treatment of asymptomatic CD may reduce the excessive risk of severe complications, leading to higher QOL nor that it is cost-effective. Conclusions: Current evidence is not sufficient to support mass screening for CD, but active case-finding may be appropriate, as we recognize that most patients with CD will still be missed by this strategy. Although proof of benefit is still lacking, screening for CD may be appropriate in high-risk groups.

At-Risk Screened Children with Celiac Disease are Comparable in Disease Severity and Dietary Adherence to Those Found because of Clinical Suspicion: A Large Cohort Study

“…7 However, although celiac disease fulfils several WHO criteria for screening, the overall benefits of this approach remain controversial. 8,9 In particular, it remains unclear how well often mildly symptomatic or apparently asymptomatic screen-detected patients adhere to the demanding and socially restrictive gluten-free diet. 6,[10][11][12][13][14][15][16][17] Although untreated celiac disease is known to predispose to severe complications and incur incremental use of health care services and medicines in symptomatic patients, 9,18,19 it is obscure whether this also applies to screen-detected individuals, especially as it is possible that they have less severe histological damage 20 and subsequently better long-term outcome.…”

Prevalência de doença celíaca em crianças pertencentes a grupos de risco, com baixa estatura ou com diabetes mellitus

“…Discute-se atualmente, nos países desenvolvidos, a indicação e o benefício de programas de screening sorológico de rotina para diagnóstico de DC nestes grupos de pacientes, avaliando-se custos, frequência de exames e consequências sociais de uma dieta de exclusão de glúten, em indivíduos muitas vezes assintomáticos (LUDVIGSSON et al, 2015).…”

Unravelling the mechanisms behind the persistent gastrointestinal symptoms in celiac disease – how can they lead to better treatment outcomes?

“…However, even in these countries, most of the patients remain undiagnosed or have an unacceptably long diagnostic delay [21]. An attractive option to increase diagnostic yield would be mass screening of general population, but the overall benefits of this approach remain to be proven [22]. In any case, at least particular attention should be paid to factors associated with the delayed diagnosis [23].…”