Response to Dosanjh et al.

Abstract

To the Editor: Dosanjh et al. (1) highlight several points that are important and worthy of further discussion. The first issue with the referenced paper is the potential issue of surveillance bias and the possible increased recognition of celiac disease which may have resulted in increased diagnostic testing in later years, potentially biasing incidence estimates upwards. We agree and, thus, were careful to phrase our findings using terminologies such as “diagnosis rate” in lieu of simply “incidence rate.” However, recent work has documented a true increase in prevalence in the US population quite independent of clinical diagnosis rate (2). Furthermore, as pointed out we also highlighted the possibility for changes in diagnostic testing as an important point in the first paragraph of our discussion where it was stated that temporal trends for serologic celiac disease tests would assist in differentiating surveillance bias with true incidence changes; however, those data were unavailable. Importantly, additional studies could be undertaken using the Department of Defense serum repository to conduct serologic testing on a carefully selected subset of individuals to characterize the changes in celiac-related antibodies over time; though as noted by the authors, histology remains the gold standard for diagnosis and limitations may persist.