Many progressive-minded celiac disease researchers have encouraged serological screening for celiac disease in high risk individuals.
In other words, they would like to use blood tests to screen people who have family members diagnosed with celiac disease, even if those people aren’t experiencing any symptoms.
This has been somewhat controversial because the evidence is mixed on whether or not there are benefits to diagnosing and treating asymptomatic celiac patients. While I would think knowing if you have a serious autoimmune disease before symptoms manifest themselves would trump most other concerns, an editorial accompanying a recent Finnish study raised some interesting points (note: I added the boldface to one part of this quote):
“Because individuals with asymptomatic, undetected celiac disease consider themselves healthy, receiving a diagnosis of celiac disease and being asked to keep a gluten-free diet may actually impair quality of life. Although early detection and treatment of celiac disease in these patients may prevent complications, most people with subclinical celiac disease are likely to remain well indefinitely on a normal diet without the logistical, social, and economic burdens imposed by a gluten-free diet.”
I have covered how part of the celiac disease and depression equation involves the social and cultural difficulties of learning to live gluten-free in a gluten-rich world. But given the serious consequences of untreated celiac disease and the infamously complex web of subtle gluten intolerance symptoms, this tact somewhat surprises me.
Thankfully, however, this editorial happens to accompany a new study that may persuade doctors to more seriously consider population-based screening for celiac disease, despite this quality-of-life argument.
In the September 2014 issue of the medical journal Gastroenterology, Finnish researchers conducted a trial run on the effectiveness and value of population-based screening for celiac disease. People with direct relatives diagnosed with celiac disease who had not experienced any celiac symptoms were chosen for this study. They were screened for celiac disease using a blood test for endomysial antibodies (EmA), which is now widely viewed as the most useful and accurate of blood screenings for celiac disease.
To measure the effectiveness of screening asymptomatic individuals, researchers measured a wide range of health signals at the beginning of the study, after one year, and then again after two years. During the first year of the study, subjects were randomly placed on a gluten-free diet or on a gluten-containing diet. All subjects were placed on a gluten-free diet during the second year.
The results indicated improvement for asymptomatic celiacs on the gluten-free diet in a wide variety of measurements, including measurements of villous health, gluten antibodies, indigestion, reflux and anxiety. However, social function scores were better for the individuals on the gluten-containing diet during the first year.
The researchers concluded:
“Our randomized study showed that apparently asymptomatic EmA-positive subjects benefit from serologic screening and a subsequent GFD. The results support active screening of celiac disease in at-risk groups.”
They do note, however, that further research should be conducted, especially to include larger sample sizes and different demographics. In addition, because of the negative social functioning results, individual situations should be considered on a case-by-case basis.
