We read with interest the paper by Hin et al entitled "Coeliac
disease in primary care: case finding study" (1). As a result of their
study 30 patients were diagnosed with coeliac disease compared to 7 in the
local general hospital during the preceding 12 months. As a result of a
large-scale population screening survey we diagnosed 13 coeliacs and there
were 2 patients who presented clinically and were diagnosed prior to the
study follow up (2). Hin’s ratio of subclincal to clinical
coeliacs, 4.3:1, compares with our ratio (6.5:1) and gives some estimate
of the proportions of the "coeliac iceberg", at least, indicating
that the majority of patients with coeliac disease remain undiagnosed due
to oligosymptomatic or atypical forms. Our work confirms that of Hin in
that we have reported that coeliacs detected by screening are not "silent"
in the true sense of the word, but are simply unrecognised (3). With
reference to the prevalence of coeliac disease in the general adult
population, our work from a random sample of the Northern Ireland
population indicates that the condition has a prevalence of 1:122,
representing the highest reported prevalence of the disease in the
unselected adult population (2). We have no reason to believe that the
prevalence should be significantly different in the remainder of the
United Kingdom.
We would reiterate that an increased awareness of the various
manifestations of coeliac disease, coupled with a low threshold for
serological testing, will help to uncover many more coeliacs who could
benefit from treatment.
References
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 Johnston SD, RGP Watson, SA McMillan, J Sloan, AHG Love. The
prevalence of coeliac disease in Northern Ireland. Lancet 1997;350:1370.
3 Johnston SD, RGP Watson, SA McMillan, J Sloan, AHG Love. Coeliac
disease detected by screening is not silent - simply unrecognised. Q J Med
1998;91:853-860.
Rapid Response:
Not recognized rather than silent
We read with interest the paper by Hin et al entitled "Coeliac
disease in primary care: case finding study" (1). As a result of their
study 30 patients were diagnosed with coeliac disease compared to 7 in the
local general hospital during the preceding 12 months. As a result of a
large-scale population screening survey we diagnosed 13 coeliacs and there
were 2 patients who presented clinically and were diagnosed prior to the
study follow up (2). Hin’s ratio of subclincal to clinical
coeliacs, 4.3:1, compares with our ratio (6.5:1) and gives some estimate
of the proportions of the "coeliac iceberg", at least, indicating
that the majority of patients with coeliac disease remain undiagnosed due
to oligosymptomatic or atypical forms. Our work confirms that of Hin in
that we have reported that coeliacs detected by screening are not "silent"
in the true sense of the word, but are simply unrecognised (3). With
reference to the prevalence of coeliac disease in the general adult
population, our work from a random sample of the Northern Ireland
population indicates that the condition has a prevalence of 1:122,
representing the highest reported prevalence of the disease in the
unselected adult population (2). We have no reason to believe that the
prevalence should be significantly different in the remainder of the
United Kingdom.
We would reiterate that an increased awareness of the various
manifestations of coeliac disease, coupled with a low threshold for
serological testing, will help to uncover many more coeliacs who could
benefit from treatment.
References
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 Johnston SD, RGP Watson, SA McMillan, J Sloan, AHG Love. The
prevalence of coeliac disease in Northern Ireland. Lancet 1997;350:1370.
3 Johnston SD, RGP Watson, SA McMillan, J Sloan, AHG Love. Coeliac
disease detected by screening is not silent - simply unrecognised. Q J Med
1998;91:853-860.
Competing interests: No competing interests