Screening for celiac disease in the general population and in high-risk groups.
BACKGROUND
Celiac disease (CD) occurs in approximately 1% of the Western population. It is a lifelong disorder that is associated with impaired quality of life (QOL) and an excessive risk of comorbidity and death.


OBJECTIVE
To review the literature on screening for CD in relation to the current World Health Organization (WHO) criteria for mass screening.


METHODS
We performed a PubMed search to identify indexed papers on CD screening with a publication date from 1900 until 1 June 2014. When we deemed an abstract relevant, we read the corresponding paper in detail.


RESULTS
CD fulfills several WHO criteria for mass screening (high prevalence, available treatment and difficult clinical detection), but it has not yet been established that treatment of asymptomatic CD may reduce the excessive risk of severe complications, leading to higher QOL nor that it is cost-effective.


CONCLUSIONS
Current evidence is not sufficient to support mass screening for CD, but active case-finding may be appropriate, as we recognize that most patients with CD will still be missed by this strategy. Although proof of benefit is still lacking, screening for CD may be appropriate in high-risk groups.
Department of Paediatrics, Örebro University Hospital, Örebro, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Jonas F
JF
Ludvigsson
Department of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
Timothy R
TR
Card
School of Medicine, University of Tampere, Tampere, Finland ; Department of Internal Medicine, Hospital, Tampere University Hospital, Tampere, Finland ; Department of Internal Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
Katri
K
Kaukinen
Department of Medicine, C Bonorino Udaondo Gastroenterology Hospital, Universidad del Salvador, Buenos Aires, Argentina.
Julio
J
Bai
Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
Fabiana
F
Zingone
Regional GI and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK.
David S
DS
Sanders
Department of Medicine, Department of Immunology, Mayo Clinic College of Medicine, Rochester, USA.
Joseph A
JA
Murray
Celiac disease; World Health Organization; gluten; gluten-free diet; prevention; quality of life; review; risk; screening