Table 4

CD as a candidate for general population screening

WHO criteriaComment
That the disease is common and well definedCD occurs in approximately 1% of the western population,24 111 and is even more frequent in selected populations.207 208
Screening tests are simple, safe and accurateIgA-TG2 screening offers high sensitivity and specificity but the positive predictive value does not attain 100%,83 with a consequent risk of false-positive cases.92 209
The screening test should be culturally acceptableScreening seems to be culturally accepted in most parts of the world
Treatment is availableGFD offers symptomatic relief and will often lead to mucosal healing.
Clinical detection is difficultThe clinical picture of CD varies, and many patients only have minor symptoms,31 208 210 making it difficult to diagnose CD.
If undiagnosed and untreated the disease will lead to severe complicationsThe only available treatment is a GFD. The GFD seems to reduce symptoms and the risk of complications in symptomatic patients,211–213 but it is doubtful whether the GFD leads to health gains in asymptomatic patients,81 214–218 219 although it should be noted that a proportion of patients who first claim to be asymptomatic in fact have symptoms.216 It is also unclear if QoL in patients with screen-detected asymptomatic CD is different81 214 217 220–223 from that of the control populations. Without a decrease in pre-diagnostic QoL, institution of a GFD is unlikely to result in improved QoL after diagnosis.
Testing and treatment is cost effectiveCost effectiveness depends on the duration of symptoms and the risk of complications in untreated versus treated CD. It is still not clear if the risk of complications is substantially lower in diagnosed CD than in undiagnosed CD.
  • CD, coeliac disease; GFD, gluten-free diet; QoL, quality of life; TG2, transglutaminase 2.