Urinary Tract Infection
Abstract
the editorialist replies: In their letter, Drs.Lebwohl and Green reiterate the controversial implications of undiagnosed asymptomatic celiac disease that I raised in my editorial.A rigorous review of the evidence-based literature on this issue would confirm that the question of whether it is appropriate to identify clinically silent cases of celiac disease as a preventive form of intervention for negative clinical outcomes is far from settled.Theoretically, only prospective clinical studies (which are ethically inconceivable) could establish in a convincing fashion the possible complications of untreated celiac disease in the absence of symptoms.It is for this very reason that I strongly support the concept of a systemic process of case finding, 1 in which patients with symptoms or conditions known to be associated with celiac disease are specifically identified. 2 This approach is associated with high levels of compliance with treatment, 3 is a terrific vehicle for educating health care professionals, is cost effective, and will probably pave the way for more sensitive and specific algorithms for the diagnosis of celiac disease.
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