Screening for coeliac disease--has the time come for mass screening?

Several recent studies, in particular the Italian SIGEP study, have demonstrated that mass screening for coeliac disease using gliadin and endomysial antibody testing is now a realistic possibility. If mass screening is to receive serious consideration then it must be shown to be (i) effective, (ii) acceptable, and (iii) worthwhile (cost-effective). At present there is insufficient evidence as to the health benefits from treating screen-detected disease and as to the size of the risks associated with having undetected coeliac disease. It is also unclear whether truly asymptomatic screen-detected coeliacs will accept long-term dietary restriction. To answer these questions randomized trials of screening are needed. On current evidence, mass screening cannot be justified. Efficient case-finding may prove as effective and more acceptable.