Published 17 September 2009, doi:10.1136/bmj.b3674
Cite this as: BMJ 2009;339:b3674

Head to Head

Should we screen for coeliac disease? No

¹ Department of Gastroenterology, Sheffield Teaching Hospitals Trust, Sheffield S10 2JF

Coeliac disease often goes undiagnosed. Alessio Fasano (doi:10.1136/bmj.b3592) argues that screening would prevent considerable morbidity, but Kate Evans and colleagues think we do not know enough about the effects on people without symptoms

The first 150 words of the full text of this article appear below.

Coeliac disease is common, can be detected by a cheap accurate test, and there is an effective treatment that can reduce morbidity and severe complications. So of course we should screen for it. Or should we? Controversies of diagnosis, a poor understanding of the natural course of coeliac disease, difficulties with adherence to a gluten-free diet, and a lack of cost effectiveness all suggest caution before we implement population screening.

Coeliac disease is detected using tests for tissue transglutaminase or endomysial antibodies. In combination these antibodies have a positive predictive value above 90% in selected groups,^{1 2} although it falls to around 70% in the general population.³ Furthermore, serological positivity can be transient or fluctuating. Simell and colleagues showed that seropositive children carrying the genetic risk of coeliac disease could become seronegative spontaneously—a concept labelled as immune tolerance.⁴

Additional logistical problems were highlighted in a recent screening study that identified 26/1868 . . . [Full text of this article]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Should we screen for coeliac disease? Yes

Alessio Fasano
BMJ 2009 339: b3592. [Extract] [Full Text]

Pre-endoscopy serological testing for coeliac disease: evaluation of a clinical decision tool

Andrew D Hopper, Simon S Cross, David P Hurlstone, Mark E McAlindon, Alan J Lobo, Marios Hadjivassiliou, Marion E Sloan, Simon Dixon, and David S Sanders
BMJ 2007 334: 729. [Abstract] [Full Text] [PDF]

Malignancy and mortality in people with coeliac disease: population based cohort study

Joe West, Richard F A Logan, Chris J Smith, Richard B Hubbard, and Timothy R Card
BMJ 2004 329: 716-719. [Abstract] [Full Text] [PDF]

Rapid Responses:

Read all Rapid Responses

Should we screen for coeliac disease? Depends on your zipcode

Rebecca Herman
bmj.com, 26 Oct 2009 [Full text]

Online poll

Find out more on doc2doc >>