Population level screening for celiac disease: is now the time?

Abstract

Purpose of review As incidence and prevalence of celiac disease is increasing, subclinical and asymptomatic presentations are more commonly identified through celiac disease screening. However, the United States Preventive Services Task Force released a statement in 2017 maintaining that there is insufficient evidence to recommend general population screening for celiac disease for asymptomatic individuals. This review summarizes the current available evidence on celiac disease screening. Recent findings Literature demonstrates that by limiting screening to individuals with recognized symptoms, celiac disease diagnosis is frequently delayed or missed entirely. Most individuals with screening-identified celiac disease have previously unrecognized symptoms that improve through treatment with a gluten-free diet. Screening-identified individuals also demonstrate signs of impaired nutrition, growth, bone health, and quality of life which improve with treatment. Overall, celiac disease screening is viewed favorably by those identified through celiac disease screening programs. Summary Individuals with screening-identified celiac disease may still incur complications from untreated disease and receive benefit from treatment with a gluten-free diet. More data is needed to determine the cost effectiveness of different mass screening approaches that incorporate the societal perspective towards screening.

Evolution in coeliac disease diagnosis and management

“…From serology‐based population studies, 50–80% of patients are estimated being unaware of their CD diagnosis. 5 , 27 , 28 Diagnostic delay is common, and while a mean delay of up to 13 years has been reported, a delay of only 3 years is still associated with decreased quality of life and excess doctor visits, days of sickness, and use of pharmaceutical agents before diagnosis. 29 Despite underdiagnosis, universal screening is contentious due to a paucity of data on both the benefits and harms of screening an asymptomatic population and treating screen‐detected disease.…”

“… 5 As a result, case finding in individuals with suggestive signs or symptoms and targeted screening of high‐risk groups such as those with a positive family history of CD is recommended. 28 However, population studies reveal a high burden of undiagnosed CD in the community that would not be detected through these approaches. Most children and adults with screen‐identified CD have previously unrecognized symptoms and many have reduced nutritional indices, bone density, and quality of life that improve with a GFD.…”

“…Most children and adults with screen‐identified CD have previously unrecognized symptoms and many have reduced nutritional indices, bone density, and quality of life that improve with a GFD. 28 A mass population CD and type 1 diabetes screening study in Colorado, US, revealed 2.4% of children had previously undiagnosed CD autoimmunity (positive serology) and 90% did not have a positive family history for CD. 30 After 1 year of follow‐up on a GFD, there were significant improvements in mean symptom severity and frequency, normalization of iron deficiency in half, and improved health‐related quality of life scores among caregivers; further, 93% of families reported good or excellent GFD adherence.…”