Coeliac disease--has the time come for routine mass screening? In 2002--2010--2020?

It might be clinically relevant to have a very low threshold when screening for coeliac disease. The question is how low? In countries familiar with coeliac disease, the classic pattern of severe malabsorption and cachexia, as described in textbooks, has become rare. Coeliac disease is not born in the minds of doctors diagnosing dyspepsia and/or irritable bowel syndrome, or associated auto-immune diseases, such as thyroid, diabetes mellitus type I, Sjögren's disease etc. The consequence is a delay in diagnosis, with secondary problems as long term autoimmune stimulation, osteoporosis and secondary malignancies. Enteropathy associated T-cell lymphomas are well known, but considering coeliac disease in T-cell lymphomas outside the gastrointestinal tract is not yet common sense. Large-scale screening studies on coeliac disease have been published and suggest a prevalence of coeliac disease in USA, Europe, Middle-East and Australia of about 1:200. Coeliac disease can be classified due to all these studies as an important health problem. However nation-wide screening programmes have not started yet, which are common for phenylketonuria and other metabolic defects. Probably they will be initiated as pilot-studies in national programmes within 10 years at the age of 2, and due to the bimodal distribution in CD with a later peak in the fourth decade, at 40 years. Additional data about cohorts of certain age groups are mandatory (f.i. 40 and/or 60 years), while initial discussions begin with national health authorities.