• coeliac disease
• screening

I read with interest the debate pertaining to screening for coeliac disease (CD). Although one can argue that CD fulfils the tenets of any screening programme, however, we do not know the natural history of screen detected patients with CD.

Logistically when would we decide to screen—at what age and how often thereafter? Serological markers may be highly sensitive and specific but the value of these tests decrease when they are used in the general population.

Although the investigational process for population screening and case finding may be the same, there is an important ethical difference between them. If a patient seeks medical help then the physician is attempting to diagnose the underlying condition (for example: patients with CD who present with symptoms of irritable bowel syndrome). This would be classified as …