Diagnosis of celiac disease in clinical practice - Physician's alertness to the condition essential

Goals: We have for several years been training health personnel to recognize celiac disease, and have advocated serologic screening in risk groups. The aim was to establish whether this approach would offer an alternative to population screening, which has yielded a prevalence of 1% in Finland. Background: The number of detected celiac disease cases is much lower than that obtained in serologic screening studies. Study: Nationwide recommendations for the detection of celiac disease were published in 1998, and training of health personnel took place in 2001 to 2002. The prevalence of celiac disease was calculated from the national registry of patients receiving reimbursement for dietary costs, attested by physician's statement. In 1 of the 10 statements the diagnostic criteria and clinical manifestations were scrutinized. Results: The nationwide prevalence of celiac disease was 0.45%; 0.7% in the highest to 0.3% in the lowest area. The annual number of new patients increased from 5/100,000 in the early 1980s to 20/100,000 today. The percentage of patients found in risk groups (relatives of celiac disease patients, patients with extraintestinal symptoms or concomitant autoimmune disorders) was currently 16.3% in the high and 6.6% in the low prevalence area. Seventeen percent of patients had dermatitis herpetiformis, and its incidence was declining. Conclusions: A maximal prevalence of 0.7% of celiac disease was ascertained; educating primary health care staff regarding the protean manifestations of the disease seemed to be the key issue. The increase in incidence implies that a prevalence of 1.0% is possible, rendering population screening unnecessary.