Volume 176 - Issue 6
High prevalence of coeliac disease in a population-based study from Western Australia: a case for screening?
Authors: John K Olynyk, Digby J E Cullen, Guy Vautier, Judith A Collett, Dominic F Mallon and Chris J Hovell
Med J Aust 2002; 176 (6): 298. || doi: 10.5694/j.1326-5377.2002.tb04421.x
Published online: 18 March 2002
Published online: 18 March 2002
In reply: We agree with Ryan that coeliac disease is common in the Australian community, with a prevalence of 1 in 250.1 Furthermore, all individuals positive for antiendomysial antibody who undergo small-bowel biopsy have typical features of coeliac disease.1 Clearly, there is a need to increase awareness relating to coeliac disease and determine appropriate screening strategies for our population.
Ryan suggests that patients presenting for upper gastrointestinal endoscopy represent a group in whom a high diagnostic yield of coeliac disease is expected. However, clinical expression of the disease is variable.1 In this setting, we believe that it is important to determine the cost-effectiveness of the various screening strategies before introducing broad-based screening.3 There is no doubt that treatment of symptomatic patients who present with coeliac disease is appropriate, but there are limited data on outcomes for asymptomatic patients who are discovered in population-based screening programs.
As we stated in our article, we recommend screening by serology and small-bowel biopsy if the clinical suspicion is high or the patient is in a high-risk group.
References
- Hovell CJ, Collett JA, Vautier G, et al. High prevalence of coeliac disease in a population-based study from Western Australia: a case for screening? Med J Aust 2001; 175: 247-250.
- Ryan J. Case 5-2001: unsuspected celiac disease [letter]. N Engl J Med 2001; 344: 1950-1951.
- Navab F. Case 5-2001: unsuspected celiac disease [letter]. N Engl J Med 2001; 344: 1951-1952. BABFEHHH
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