IS CELIAC DISEASE SCREENING IN RISK GROUPS JUSTIFIED? A LONG-TERM FOLLOW-UP STUDY

Abstract

Aim: The benefits of celiac disease (CD) screening are debatable and the compliance to gluten-free diet (GFD) in screen-detected patients is thought to be poor; we investigated the dietary compliance, quality of life (QoL), physical well-being and bone mineral density in screen-detected CD patients after long-term treatment. Methods: 53 consecutive screen-detected CD patients (both children and adults at the diagnosis of CD) were enrolled to follow-up study after median of 14 (range 5-21) years of commencement to GFD; screening was carried out because of family history of CD or associated autoimmune diseases. Dietary compliance was assessed by an interview, a 4-day food record and CD serology. QoL was evaluated by Psychological General Well-Being (PGWB), SF-36 and gastrointestinal symptoms by Gastrointestinal Symptom Rating Scale·questionnaires. The results were compared to those in 44 symptom-detected treated CD patients, non-CD controls and general population. Results: The long-term compliance to GFD did not differ significantly between screen-detected and symptom-detected CD patients, being good in 83% and 77% respectively. QoL was as good in screen-detected treated CD patients as in symptom-detected CD and nonceliac controls when measured by PGWB. Mean value of mental health in SF-36 was significantly better in screen-detected treated CD than in the general population; in other items there was a similar tendency. Screen-detected long-term treated CD patients had slightly less abdominal symptoms and better bone mineral density than symptom-detected treated CD patients (not significant). Summary: Long-term compliance to GFD in screen-detected CD patients was good. Despite evident dietary restrictions, the QoL was comparable to that of symptom-detected patients, and even to non-celiac controls or general population. Conclusions: In terms of QoL and compliance CD screening and early treatment seems to be conceivable in CD risk groups. These data can be applied when decisions about mass-screening of CD in general population are rationalized.