Celiac Disease fulfills the requirements for a worthwhile screening program:

1. It is a common disorder causing significant morbidity in the general population.

2. Early detection is often difficult on a clinical basis.

3. If not recognized, the disease can manifest itself with severe complications that are difficult to manage (eg. infertility, osteoporosis, lymphoma).

4. There is an effective treatement, the gluten-free diet.

5. Sensitive and simple screening tests are available (eg. the anti t-TG test).

- Catassi, C., and Fasano, A. 2001. Current approaches to diagnosis and treatment of celiac disease: An evolving spectrum. Gastroenterology, 120: 636-651.

So why haven’t we done it yet? Because the natural history of the disease is unknown still, because we haven’t figured out the appropriate age to screen for CD (or whether we should do it ever five years or so), and because there are ethical implications to administering a gluten-free diet to people with “silent” celiac disease (it impedes the patients’ quality of life).

The same researchers also found that an “increased awareness of the extraintestinal manifestations of CD, coupled with a low threshold for serologic testing,” (meaning that they administer it liberally), “uncovers a large portion of the submerged iceberg” (Catassi, 2001).

The issue then, is still to educate doctors, nutritionists, and naturopaths on CD and the many disorders associated with it.

I still think that mass screening will occur in populations around North America, and not long from now. Maybe not nation wide, but mark my words, it will happen in some way.