Who Should Be Screened for Celiac Disease and When?

Celiac.com 05/19/2015 - What should be the screening standards for celiac disease in the general population, and in high-risk groups?

To gain an answer, a team of researchers recently set out to review medical literature on screening for celiac disease in relation to the current World Health Organization (WHO) criteria for mass screening.

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The research team included J.F. Ludvigsson, T.R. Card, K. Kaukinen, J. Bai, F. Zingone, D.S. Sanders, and J.A. Murray. They are variously affiliated with Department of Paediatrics, Örebro University Hospital, Örebro, Sweden, the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, the Department of Epidemiology and Public Health at the University of Nottingham in Nottingham, UK, the School of Medicine at the University of Tampere, the Department of Internal Medicine at Tampere University Hospital in Tampere, Finland, the Department of Internal Medicine at Seinäjoki Central Hospital in Seinäjoki, Finland, the Department of Medicine at C. Bonorino Udaondo Gastroenterology Hospital at the Universidad del Salvador in Buenos Aires, Argentina, the Department of Medicine and Surgery at the University of Salerno in Salerno, Italy, the Regional GI and Liver Unit at Royal Hallamshire Hospital in Sheffield, UK, and with the Department of Medicine and the Department of Immunology at the Mayo Clinic College of Medicine in Rochester, USA.

For their study, the team conducted a PubMed search to identify indexed papers on celiac disease screening published between 1900 and 1 June 2014. The team then read the papers for all relevant abstracts.

They found that, although celiac disease fulfills several WHO criteria for mass screening, such as high prevalence, and available treatment and difficult clinical detection, current medical evidence does not support mass celiac disease screening,

Also, treatment of asymptomatic celiac disease not been shown to be cost effective, nor likely reduce the excessive risk of severe complications, thus leading to higher QOL

The team points out that active case-finding may be appropriate, even though many celiac patients will still be missed by this strategy.

They also note that, even though proof of medical necessity or benefit is still lacking, mass celiac disease screening may be appropriate for high-risk groups.

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