To the Editor:

The headline in Bettie Coplan's article about celiac disease (“Common signs and symptoms, and a diagnosis that is often overlooked,” published in December 2009) is fitting: celiac disease is very common, affecting approximately 1% of the US population, and it is often overlooked, resulting in 95% of cases are either undiagnosed or misdiagnosed. The poor diagnosis rate is attributed to a lack of awareness among healthcare professionals.1,2 The belief was that GI symptoms were the typical presentation; we now know that the most prevalent form of the disease is “atypical,” affecting areas outside the small bowel.3 The range of symptoms complicates its identification. Because celiac disease is a disease of malabsorption, it may involve any part of the body, including the reproductive, neurologic, hematologic, skeletal, and dental systems.

Ms. Coplan offered a broad summary of the testing process and the disease's treatment, the gluten-free diet. Because recognition of the symptoms must occur before practitioners consider the disease and pursue screening, more comprehensive information that supports detection is needed for health care providers to include celiac disease in their differential diagnosis.

Hopefully, Coplan's article helped readers realize that a greater awareness is needed in the medical community and piqued their interest to learn more. The National Foundation for Celiac Awareness (NFCA) has developed several on-line continuing medical education programs that provide the resources needed to become literate in celiac disease diagnosis and treatment. One such program, GREAT Family Practitioners, is accredited by the American Academy of Family Practitioners for 2.0 CME; this program is available online at www.celiaccentral.org/Education/GREAT-Healthcare/222/. For additional information and education programs, visit the National Foundation for Celiac Awareness Web site (www.CeliacCentral.org).

Loretta Jay, MA
Director of Program Development
National Foundation for Celiac Awareness

REFERENCES

1. Zipser RD, Farid M, Baisch D, et al. Physician awareness of celiac disease: a need for further education. J Gen Intern Med. 2005;20(7):644-646.

2. Collin P, Huhtala H, Virta L, et al. Diagnosis of celiac disease in clinical practice: physician's alertness to the condition essential. J Clin Gastroenterol. 2007;41(2):152-156.

3. Rostami Nejad M, Rostami K, Pourhoseingholi MA, et al. Atypical presentation is dominant and typical for coelic disease. J Gastrointestin Liver Dis. 2009;18(3):285-291.