Serological Diagnosis of Celiac Disease ?Moving Beyond the Tip of the Iceberg

The majority of celiac disease affected patients are undiagnosed. Since the epidemiology and phenotype of CD is constantly changing towards latent, hyposymptomatic or asymptomatic behavior and since there is an increased risk of complications, early diagnosis and subsequent adherence to gluten-free diet is highly recommended. Multiple serological tests are on the market and the most frequently used test is IgA-tTG. This is not sensitive enough to be used alone, and combined tests enhance detection. Several combinations have been studied but not accurately compared to each other. The most frequently used combination is anti IgG-DGP with IgA-tTG, however, increasingly the new generation of anti neo-epitope DGP+tTG IgG+IgA is being used. At present, there is insufficient information to demonstrate that screening general populations definitely results in clinical benefit. However, asymptomatic individuals in high-prevalence groups should be screened.