Individual Screening Effectiveness for Celiac Disease

Celiac disease is an autoimmune condition which mainly affects the person’s digestive tract. Specifically, the patient becomes unable to consume gluten due to the damaging effect the protein has on his or her small intestines. Gluten, on the other hand, is a protein present in wheat, barley, and rye, and in other products such as medication, vitamins, supplements, lip balms, and even in the adhesive in stamps and envelopes. The presence of the protein in virtually every element of a person’s daily life makes this disease all the more cumbersome. The individual must take special precautions to not come into contact with it, and suffer from any of its symptoms.

The curious thing about celiac disease is that it affects each person differently, so the symptoms might not always be the exact same in each case. For instance, while the symptoms may manifest in the patient’s digestive system, they are not limited to this part and may surface in other areas. In this sense, after a person with celiac disease is exposed to gluten, he or she may manifest symptoms such as abdominal pain and diarrhea, while others might experience depression, anxiety, or irritability. Conversely, some individuals might suffer from celiac disease, but might occasionally show no symptoms after exposure to gluten, which can make detection and further treatment more complicated than usual.

As many celiac disease sufferers might already know, this condition is genetic. That being said, blood analysis tests might provide specialists with valuable insight to help them identify and diagnose the disease. Furthermore, physicians can also perform tests using samples from the person’s small intestine to detect the condition with increased accuracy. The treatment, regrettably, is limited to a gluten-free diet.

Fortunately, recent studies have shown that, in most cases, prevention of diseases is usually more cost-effective than finding cures — and celiac disease is not an exception.

The American Gastroenterological Association

The American Gastroenterological Association — or AGA, for short — is the voice of the gastrointestinal community. Founded in 1897, the AGA has grown from relative obscurity in the late 20th century, to include over 17,000 clinicians as of 2013. Said professionals are involved in all the aspects of the science, from GI research and study to the development and practice of methods to improve the lives of patients that suffer from GI diseases. Celiac disease is a condition which has garnered lots of attention in recent years due to its increasing incidence and varying symptoms which can impair or significantly reduce the quality of life of sufferers.

The AGA is hard at work in researching new and improved methods to reduce the disease’s symptoms with the hopes of developing a cure for it in the future. Similarly, this organization has taken it upon itself to developing methods which allow celiac sufferers to experience life in the fullest, unimpeded by their disease. The following early screening method has been practiced by clinicians of the AGA and has helped improve the quality of life of celiac sufferers since its inception in 2013.

Screening Teens for Early Celiac Disease Detection

Celiac disease has been a part of us for as long as we have existed as humans. In 1888, Samuel Gee did the first ever clinical description of celiac disease, which was very rigorous and detailed. He suggested that, if there should ever be a cure, it would be achieved through the patient’s diet.

While Gee was not very far away from the modern cure and procedures used to treat celiac disease today, modern medicine has revealed that screening at-risk patients from as early as their teens is much more cost-effective than waiting until the condition manifests in adulthood. Doctors in Bethesda, Maryland have, since 2013, adopted the standard practice of screening teens who show many of the signs and symptoms of celiac disease, as opposed to universal screening for patients of all ages. This practice offers an effective way to predict and prevent bone loss and fractures in said celiac patients. The disease is known to commonly affect the patient’s bones and its early detection is paramount to preventing its symptoms and unfortunate side effects.

Since celiac disease has a huge genetic factor, the children of celiac sufferers have increased probability of also suffering from it as they mature and develop. In this regard, it makes financial sense to exclusively screen adolescents who are at a high-risk of developing celiac disease. Furthermore, besides being financially intensive, universal screening has proven to be a strategy which fails to increase the quality of life of the population as a whole and exposes healthy individuals to harmful endoscopic treatments. These treatments may put their lives at risk, or at least cause significant discomfort. 

When it comes to effectiveness in detection, both methods share similar statistics, as they are both great procedures for this purpose. Nevertheless, the selective screening of high-risk patients showed to be ultimately more cost effective — by a margin of almost $60 per patient — for individuals. This is important for those who don’t have insurance coverage, and that require the most effective treatments without having to break the bank.

The only major drawback of selective screening is that, more often than not, some patients may escape detection due to the asymptomatic nature of their disease. A factor which is further compounded when considering the possibility of inactive conditions suddenly becoming symptomatic and causing complications for individuals who were originally deemed healthy. However, Dr. Park, M.D — of the division of gastroenterology, hepatology and nutrition, department of pediatrics at Stanford University — has stated that “adopting universal screening to prevent bone disease and subsequent non-traumatic fractures alone in undiagnosed or untreated celiac disease patients does not appear to be a viable health policy to the standard of care”.

As matters stand today, the universal screening for celiac and bone disease is not a cost-effective alternative for the undiagnosed patient. However, this may stand to change in the future as additional conditions such as anemia, infertility, and malignancy — possible side-effects of celiac disease — also become a subject of study on celiac patients. As additional side effects are added to the equation, the financial viability of universal screening may begin to improve. Regardless, until now, the best solution in terms of budget and permanence is to exclusively screen high-risk patients in their teens.