title: Diagnosis of celiac disease in clinical practice: physician's alertness to the condition essential.
abstract: OBJECTIVE
  We have for several years been training health personnel to recognize celiac disease, and have advocated serologic screening in risk groups. The aim was to establish whether this approach would offer an alternative to population screening, which has yielded a prevalence of 1% in Finland.
  
  
  BACKGROUND
  The number of detected celiac disease cases is much lower than that obtained in serologic screening studies.
  
  
  METHODS
  Nationwide recommendations for the detection of celiac disease were published in 1998, and training of health personnel took place in 2001 to 2002. The prevalence of celiac disease was calculated from the national registry of patients receiving reimbursement for dietary costs, attested by physician's statement. In 1 of the 10 statements the diagnostic criteria and clinical manifestations were scrutinized.
  
  
  RESULTS
  The nationwide prevalence of celiac disease was 0.45%; 0.7% in the highest to 0.3% in the lowest area. The annual number of new patients increased from 5/100,000 in the early 1980s to 20/100,000 today. The percentage of patients found in risk groups (relatives of celiac disease patients, patients with extraintestinal symptoms or concomitant autoimmune disorders) was currently 16.3% in the high and 6.6% in the low prevalence area. Seventeen percent of patients had dermatitis herpetiformis, and its incidence was declining.
  
  
  CONCLUSIONS
  A maximal prevalence of 0.7% of celiac disease was ascertained; educating primary health care staff regarding the protean manifestations of the disease seemed to be the key issue. The increase in incidence implies that a prevalence of 1.0% is possible, rendering population screening unnecessary.
authors.affiliation: Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Medical School, Tampere, Finland. pekka.collin@uta.fi
authors.forename: Pekka
authors.initials: P
authors.lastname: Collin
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.forename: Lauri
authors.initials: L
authors.lastname: Virta
authors.forename: Leila
authors.initials: L
authors.lastname: Kekkonen
authors.forename: Timo
authors.initials: T
authors.lastname: Reunala
mesh_terms: D000328:Adult; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D017410:Practice Guidelines as Topic