Celiac Disease. Has the Time Come for Universal Screening?

Celiac disease (CD) is a systemic immune-mediated disorder triggered by gluten ingestion in genetically predisposed individuals. Its diagnosis is based on clinical suspicion, detection of specific antibodies, and, in some cases, intestinal biopsy. However, a significant proportion of patients remain undiagnosed due to the variability of its clinical presentation.

In September 2023, Italy approved universal CD screening for children aged 1 to 17 years based on studies that revealed that 60% of cases diagnosed through screening had not been previously identified. This decision has reignited the debate on the feasibility of mass detection of the disease. While CD meets most of the classical screening criteria, uncertainties persist regarding the benefit of diagnosing asymptomatic individuals, as evidence on the prevention of severe complications in this group remains limited.

The implementation of universal screening poses methodological challenges, such as the risk of false negatives and program costs. Intermediate approaches, such as active case-finding in high-risk populations or opportunistic screening, could be viable alternatives. The decision to adopt universal screening will depend on the 'hidden prevalence' of the disease in each country and the healthcare system's capacity to improve clinical detection.