To the Editor: We read with interest the study of Kinos et al (1) dedicated to the burden of illness in children with screen-detected coeliac disease (CD). The study highlights the concept of “clinical iceberg”: by reason of heterogeneous clinical presentation, CD remains markedly underdiagnosed. Nevertheless, doubts persist about the need for screening programs and their effectiveness (2). Kinos et al, using a baseline questionnaire before diagnosis and a follow-up questionnaire after 1 year of gluten-free diet (GFD), concluded that screen-detected children demonstrate benefits from treatment and satisfactory dietary adherence similar to symptom-detected patients. Unfortunately, as acknowledged by the authors, screen-detected patients belong to at-risk groups and 65% of them complain of faded prediagnosis symptoms. The presence of only asymptomatic patients would have given the most significant elements of the discussion. According to our experience about salivary screening among 5000 6- to 8-year schoolchildren (3), 5 years after diagnosis, the 28 patients still have a complete adherence to the diet and show excellent growth parameters. In addition, in the Coeliac Disease DUX questionnaire they reached similar results compared with the symptomatic patients of van Doorn's study (4). We also believe that the age range 1 to 15 years is too broad: it encompasses childhood and adolescence, 2 periods rich in substantial differences in terms of compliance with GFD. One year of GFD may be too short to draw conclusions about the success of screening. In conclusion, we wish to highlight the benefits of screening programs for CD if performed in the preadolescent years and if supported by an effective follow-up.
1. Kinos S, Kurppa K, Ukkola A, et al. Burden of illness in screen-detected celiac disease children and their families: a nationwide prospective study. J Pediatr Gastroenterol Nutr
2012 May 18. [Epub ahead of print]
2. Hoffenberg EJ, Liu E. Screening-identified celiac disease: who needs treatment and when? Clin Gastroenterol Hepatol
3. Bonamico M, Nenna R, Montuori M. First salivary screening of celiac disease by detection of anti-transglutaminase autoantibody radioimmunoassay in 5000 Italian primary schoolchildren. J Pediatr Gastroenterol Nutr
4. van Doorn RK, Winkler LM, Zwinderman KH, et al. CDDUX: a disease-specific health-related quality-of-life questionnaire for children with celiac disease. J Pediatr Gastroenterol Nutr