Support for population-wide coeliac disease screening

Screening for coeliac disease is a contentious issue primarily as the cost of the process compared to the beneficial outcomes have not yet been thoroughly explored.

A study conducted in the Netherlands has shown population-wide screening is effective in improving the quality of life for those diagnosed with the condition. As a result, the researchers who conducted the study have proposed small-scale population screening programs, supported by prospective evaluation of the costs and benefits of the screening.

In 1998, the parents of 12,672 children aged 2 to 4 years were invited for a mass screening of coeliac disease. Thirty-two children were identified as having coeliac disease. Over a ten year period, these children were studied to evaluate the effectiveness of different forms of treatment resulting from detection of their coeliac disease. Follow-up sessions were conducted in 1999, 2000, 2001, 2002, 2003, and 2007, where health status was assessed by questioning 5 symptoms (abdominal pain, diarrhea, constipation, irritability, and lassitude) and by recording any other symptoms that were brought up by the patients or their parents.

In total, 19 of the children were treated with a gluten-free diet and 13 continued their normal gluten containing diet. Some children in the latter group changed to a gluten-free diet during the follow-up period. Six of the 32 children displayed no symptoms of coeliac disease despite testing positive in the screening process. These children continued to consume gluten throughout the study, and remained symptom-free. The remaining 26 children adhered to a gluten-free diet throughout the course of the ten year study and 17 of them had improved their health status. All 26 bettered their health-related quality of life after one year. After a decade, their quality of life was similar to those without the disease.

The study’s authors maintain that treatment may be delayed for those children who test positive for coeliac disease but have no symptoms. However, longer-term studies are needed to assess possible long-term complications in untreated asymptomatic coeliac disease.

Reference: van Koppen et al. 2009. Pediatrics. Vol 123 pp e582-e588.
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