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European and North American populations should be screened for coeliac disease
  1. A Fasano
  1. A Fasano Division of Pediatric GI and Nutrition, Center for Celiac Research, University of Maryland School of Medicine, P.O. Box 140, 22 S Greene St, Baltimore, MD, USA;
    afasano{at}peds.umaryland.edu

https://doi.org/10.1136/gut.52.2.168

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    Coeliac disease (CD) is an immune mediated enteropathy triggered by ingestion of gluten containing grains in genetically susceptible individuals.1 CD is associated with HLA alleles DQ2 and/or DQ8, and in the continued presence of gluten the disease is self perpetuating.1,2 To sustain the position that active screening in search of CD cases is a justified policy, we will review the WHO guidelines for disease mass screening recommendations to establish whether CD satisfies these criteria.3

    WHO CRITERIA FOR MASS SCREENINGS

    1. Early detection of the disease could be difficult on a clinical basis.

    2. The disease must be a common disorder causing significant morbidity in the general population.

    3. The screening tests must be highly sensitive and specific for the target disease.

    4. A treatment for the disease must be available.

    5. If not recognised, the disease could result in severe complications difficult to manage.

    EARLY DETECTION

    CD can manifest with a previously unsuspected range of clinical presentations, including the typical malabsorption syndrome (chronic diarrhoea, weight loss, abdominal distension) and a spectrum of symptoms …

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