Editor,—The paper by Gale et al(Gut 1997; 40: 492–6) fails in its aim to investigate the association between coeliac disease and Down syndrome. The authors use methodology for screening they have stated to be outdated. In a vulnerable population this is ethically unsound and inaccurate conclusions are drawn from incomplete data.

Editor,—The paper by Gale et al(Gut 1997; 40: 492–6) fails in its aim to investigate the association between coeliac disease and Down syndrome. The authors use methodology for screening that they have stated is outdated. In a vulnerable population this is ethically unsound and inaccurate conclusions are drawn from incomplete data.

The increased frequency of raised antigliadin levels (and of autoimmune antibodies) in individuals with Down syndrome are already well documented, as is the increased prevalence of coeliac disease.1 ,2 Incidence cannot be assessed by screening.

Serological screening by antigliadin antibodies alone is outdated and the usefulness of antiendomysial antibody levels, which can be easily measured using a commercial kit or human umbilical cord, is well established.3 To compound this error, the authors only regard individuals who have elevated titres of both IgA and IgG …