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  1. Alessio Fasano, director
  1. 1Mucosal Biology Research Center and Center for Celiac Research, University of Maryland School of Medicine, Baltimore, MD 21201, USA
  1. afasano{at}mbrc.umaryland.edu

    Coeliac disease often goes undiagnosed. Alessio Fasano argues that screening would prevent considerable morbidity, but Kate Evans and colleagues (doi:10.1136/bmj.b3674) think we do not know enough about the effects on people without symptoms

    Coeliac disease is an immune mediated enteropathy triggered by the ingestion of gluten, the major protein component of wheat, and related proteins in rye and barley, in genetically susceptible individuals.1 It is one of the most common lifelong disorders, affecting 0.5-1% of the population.2 Many of those affected are not diagnosed because of the wide spectrum of clinical presentations. People who remain undiagnosed are at risk of long term complications, including infertility, osteoporosis, and lymphoma. Therefore prompt diagnosis is important not only to enable appropriate treatment of symptoms but to prevent future complications. Since diagnosis currently takes 7-10 years,3 serological screening will increase the quality of life for many people.

    Increased awareness of the disease, coupled with a low threshold for serological testing, …

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