By Allergen Bureau

Number of children with coeliac disease doubles, but should we be screening?

A new study has added to the growing evidence base that rates of coeliac disease are rising, yet many people are not diagnosed. By screening almost 6,000 Italian children aged 5 – 11 years, 1.6 per cent were found to have coeliac disease, compared with estimates that approximately 1 per cent of the global population has the condition. Compared with results from a similar study by the same group 25 years ago, the rate of coeliac disease among children appears to have doubled.

Early detection can help those with coeliac disease adhere to a gluten-free diet, thereby avoiding damage to the gut lining that causes symptoms such as bloating, pain, diarrhoea, anaemia, and other conditions connected to malabsorption of nutrients, including fatigue, osteoporosis, and fertility problems. In infants and children, coeliac disease can cause abdominal pain, bloating, and vomiting, as well as lead to poor growth and delay puberty.

Screening programs among school-aged children such as the Italian CELI SCREEN multi-centre trial leads to more cases of coeliac disease being diagnosed than in standard care, where children are only tested if they present with symptoms, or are screened because of a family history of the disease.

However, conducting mass screening for coeliac disease remains controversial. Many believe there is not yet sufficient evidence to assess the balance of benefits and harms of screening for coeliac disease in those who do not experience symptoms. Much of the argument for mass screening is based on the assumption that those with a formal diagnosis will adhere to a lifelong gluten-free diet, thereby avoiding the morbidity and mortality associated with the disease.

An original Open Access paper in BMC Gastroenterology presents an economic perspective of mass screening in Sweden. Results from the Italian CELI SCREEN trial were presented this month at the 6th World Congress of Paediatric Gastroenterology, Hepatology and Nutrition.