Do we have to screen the general population for coeliac disease instead of only patients with so-called associated diseases?

Abstract

C. J. J. Mulder The article by Zauli et al. (Digest Liver Dis 2000;32:775-9) suggests that it might be clinically relevant to have a lower threshold when screening for coeliac disease (CD) in atopics ‘. In 1888, Samuel Gee published his classic description of CD 2. He suggested that the condition may be cured by a diet. Dicke demonstrated, in the 1930’s, that removal of wheat from the diet alleviated symptoms and signs of CD 3. Paulley, in 1954, described broad villi and chronic inflammatory cells in small bowel biopsies taken from patients with idiopathic steatorrhoea 4. Whilst the pathogenesis of CD remains unknown, genetic and immunological factors are involved. Over more recent years, the classic pattern of severe malabsorption and cachexia, described in earlier textbooks, has become rare. It is obvious that, in many cases, patients do not have overt malabsorption or other classic symptoms of CD 5. Some symptoms may be attributed to CD, a possible second diagnosis may be obscure, and conversely, CD is not borne in mind in patients diagnosed as suffering from other auto-immune diseases such as thyroid disease, diabetes mellitus type I, or Sjogren’s disease. However, more and more Patient Associations are giving information to their members about being aware of so-called associated diseases. patients are asking for screening methods and the threshold for duodenal biopsies seems much lower in them due to sedation during upper GI endoscopy. Several disease have been reported to occur concomitantly with CD; reviews have described up to 100 of such disorders 6 ‘. Significant associations are likely with diseases having a similar genetic background and immunological alterations. Other associated diseases are presumably fortuitous because the prevalence of CD may be much higher than previously assumed.