Coeliac disease detected by screening is not silent - simply unrecognized

Coeliac disease (CD) is associated with a wide spectrum of clinical present ation and may be overlooked as a diagnosis. There is some evidence that unt reated Co is associated with a doubling of mortality, largely due to an inc rease in the incidence of malignancy and small intestinal lymphoma, which i s decreased by a strict gluten-free diet. We studied the clinical features of screening-detected coeliacs compared to age- and sex-matched controls as a 3-year followup to a population screening survey, and followed-up subjec ts who had had CD-associated serology 11 years previously to determine whet her they have Co or an increased mortality rate compared to the general pop ulation. Samples of the general population (MONICA 1991 and 1983) were scre ened for CD-associated serology and followed-up after 3 and 11 years, respe ctively, and assessed by a clinical questionnaire, screening blood tests an d jejunal biopsy. Mortality rates for 'all deaths' and 'cancer deaths' were compared in subjects with positive serology in 1983 with reference to the general population. Thirteen coeliacs were diagnosed by villous atrophy fol lowing screening, compared to two patients with clinically detected Co, giv ing a prevalence of 1 : 122. Clinical features or laboratory parameters wer e not indicative of CD compared to controls. Subjects with positive serolog y followed up after 11 years did not have an excess mortality for either ca ncer deaths or all causes of death. Screening-detected CD is rarely silent and may be associated with significant symptoms and morbidity. In this limi ted study with small numbers, there does not appear to be an increased mort ality from screening-detected CD, although the follow-up may be too short t o detect any difference.