High prevalence of coeliac disease in a population-based study from Western Australia: a case for screening?

To the Editor: I read with interest the recent article by Olynyk's group at Fremantle on the prevalence of coeliac disease in rural Western Australia.1

It is now increasingly realised that coeliac disease is underdiagnosed in adults because it may be clinically silent — but not necessarily asymptomatic. The symptoms, however, may be non-specific and not those traditionally associated with coeliac disease. In a recently reported small study from suburban Melbourne,2 I demonstrated that about 5% of patients (5/97) undergoing gastroscopy had coeliac disease based on small-bowel biopsy results. In only one of the patients was the disease suspected clinically.

I have used these figures to argue the case for routine duodenal biopsy at the time of gastroscopy, regardless of the indication. It is important to note that in my study none of the patients presenting with diarrhoea, and only one of six with anaemia, had coeliac disease — so that restricting biopsy to this group would have missed most patients with coeliac disease.

Timely diagnosis is important, as symptoms may be alleviated, presymptomatic nutritional deficiencies corrected, and the risk of cancer reduced by instituting a gluten-free diet. People presenting for gastroscopy represent a high-yield group for histological screening for coeliac disease in Australia.