In effect, Dr. Murray says, CD is everywhere — "a disease of the masses" — but clinicians often fail to recognize it. "If a patient with osteoporosis or infertility isn't responding to treatment, suspect celiac disease," he says. It should also be suspected in patients with type 1 diabetes, rheumatoid arthritis, Sjogren's syndrome or other autoimmune disorders, as well as in cases of irritable bowel syndrome or chronic diarrhea.
"Even after all that, most patients will elude diagnosis because the disease hasn't produced enough of an impact to cause symptoms," Dr. Murray says. That argues for universal screening. At Mayo Clinic, asymptomatic people considered at risk of gluten intolerance are routinely screened, including family members of celiac patients. Eventually, Dr. Murray thinks, celiac testing may become routine for everyone. "We're amassing more evidence to suggest that we have to screen people rather than just waiting for the disease to become apparent," he says.