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Coeliac disease in primary care: case finding study

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7177.164 (Published 16 January 1999) Cite this as: BMJ 1999;318:164

Rapid Response:

The relevance of age in screening CD

27th April 1999
The Editor
BMJ

Dear Sir,
We read with interest the paper by Hin et al. describing the prevalence of
coeliac disease (CD) in a population attending a general practice [1].
Although this paper will greatly help to diffuse among general
practitioners the concept that CD must not be suspected only in patients
presenting with a classical malabsorption syndrome, Hin et al., who
screened subjects aged between 6 months and 85 years, provided only little
information regarding the possibility that different age groups could have
different prevalences of CD.

In an adult general population we found four patients affected by CD
out of 2237 screened subjects [2]. Interestingly, none of the four
patients was aged over 40 years. Thus, in the adult general population
aged under 40 years, the prevalence of CD was 1/230 (95% Confidence
Interval 1.7-11.1‰), which is very similar to the prevalence shown by
Catassi in a neighbouring paediatric population [3]. On the other hand,
the prevalence of CD was much lower in the subjects aged both 40-59 years
(95% CI 0.0-4.8‰) and over 60 years (95% CI 0.0-7.5‰). We concluded that
the prevalence of CD is not the same in different age groups. It is likely
that, similarly to our results, the prevalence of CD was not uniformly
distributed in the sample studied by Hin. It would greatly help general
practitioners, willing to screen for CD the patients attending their
practice, to know whether different age groups have different prevalence
of CD.

It was a reason of concern to read that none of the patients
considered to be affected by irritable bowel syndrome (IBS) resulted to be
affected by CD. We showed that many patients affected by classical CD,
i.e. presenting with symptoms of frank malabsorption, had had relevant
diagnostic delay because of the fact that they had long been labeled as
affected by IBS [4]. Moreover, it emerges from Hin's paper that the
prevalence of CD among patients presenting with "malabsorption symptoms or
diarrhoea" was around 5%. Since we feel that the distinction between
patients affected by IBS or "malabsorption symptoms or diarrhoea" could be
not immediately recognised by general practitioners without a specific
interest in gastroenterology, it is crucial to know the diagnostic
criteria used by the authors to include the patients in either of the
groups in order to avoid perpetuating diagnostic delay in patients
affected by classical CD.

1. Hin H, Bird G, Fisher P, Mahy N, Jewell D. Coeliac disease in
primary care: case finding study. BMJ 1999;318:164-7.

2. Corazza GR, Andreani ML, Biagi F, Corrao G, Pretolani S, et al. The
smaller size of the "coeliac iceberg" in adults. Scand J Gastroenterol
1997;32:917-9.

3. Catassi C, Rätsch I-M, Fabiani E, Rossini M, Bordicchia F, Candela F,
et al. Coeliac disease in the year 2000: exploring the iceberg. Lancet
1994;343:200-3.

4. Corazza GR, Brusco G, Andreani ML, Biagi F, Di Stefano M, Gasbarrini G.
Previous misdiagnosis and diagnostic delay in adult celiac sprue. J Clin
Gastroenterol 1996;22:324-5.

Dr. Federico Biagi, MD
Prof. Gino R Corazza, MD

Gastroenterology Unit
University of Pavia
IRCCS Policlinico San Matteo
Piazzale Golgi, 5
27100 Pavia, Italy
Tel. 0039 0382 502974
Fax 0039 0382 502618

Competing interests: No competing interests

29 April 1999
Federico Biagi
Gastroenterology Unit, University of Pavia