Italy Tests Nationwide Screening to Catch Hidden Celiac Disease in Children

Celiac.com 12/18/2025 - This study explores the potential costs, benefits, and organizational challenges of Italy’s newly planned mass screening program for celiac disease among children. By modeling the program’s first decade of operation at a regional level, researchers sought to determine whether widespread early testing could be economically sustainable and medically worthwhile. The findings reveal that while mass screening could uncover many undiagnosed cases, it also creates significant long-term financial commitments for both the healthcare system and families.

Why Screening Matters

Celiac disease is an immune condition triggered by gluten, a protein found in wheat, barley, and rye. When a person with this condition consumes gluten, the immune system damages the small intestine, leading to malabsorption and potential complications. It affects roughly one in every hundred people worldwide, though many remain undiagnosed. Because symptoms can be mild or absent, diagnosis often comes late—sometimes after years of digestive or unrelated health issues.

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In recent years, researchers have called attention to the “coeliac iceberg,” a metaphor describing how most cases remain hidden below the surface. Traditional diagnostic strategies focus on individuals with clear symptoms, family history, or other autoimmune conditions. However, these approaches miss many people, especially children, who could benefit from early diagnosis and a gluten-free diet before serious damage occurs. Italy’s new screening initiative aims to address this gap through proactive testing in early childhood.

The Italian Screening Initiative

In 2023, the Italian Parliament approved a national program to screen for both type 1 diabetes and celiac disease in children. The program involves simple blood sampling for genetic markers (HLA DQ2/DQ8) and antibodies associated with these conditions. Children will be tested at ages 2, 6, and 10, covering key developmental periods. The long-term goal is to identify celiac disease early, reduce complications, and improve quality of life. The plan received initial government funding of several million euros to begin implementation between 2024 and 2025.

To anticipate how this plan might work in practice, researchers conducted a detailed cost and organization analysis using data from Lombardy, one of Italy’s most populous regions. They projected both the financial burden and the health system resources needed for a decade of continuous screening.

Study Design and Approach

The researchers built a model simulating a ten-year screening period. They included children aged two, six, and ten—the same age groups targeted by the national program. The model factored in not only the cost of the tests themselves, but also follow-up visits for confirmed cases and the long-term cost of providing gluten-free food and medical supervision.

Three main cost categories were analyzed:

• Screening costs – the expenses involved in testing, laboratory analysis, and staff time.
• Follow-up costs – additional appointments, monitoring, and medical care for newly diagnosed children.
• Gluten-free diet support – the ongoing cost of specialized food and dietary reimbursements provided to individuals diagnosed with celiac disease.

Demographic and health data from Italian statistics were used to estimate how many children would participate in the program and how many would likely test positive.

Key Findings

The analysis predicted that in the first four years of screening, about 3,076 new cases of celiac disease would be detected regionally. Over ten years, the total annual cost would average around 19.9 million euros. Of this, about 8.7 million euros would be spent on screening activities, 1.7 million euros on follow-up care, and approximately 9.5 million euros on lifelong gluten-free diet support.

In the early years of the program, the majority of costs come from setting up and running the testing procedures. However, as more children are diagnosed and enter lifelong treatment, the balance shifts. Over time, the cost of maintaining gluten-free diet subsidies becomes the main financial burden on the healthcare system.

The regional health service would carry roughly 18 million euros in direct annual expenses, while families would bear around 350,000 euros in indirect opportunity costs—such as time away from work for appointments and dietary management.

What These Costs Mean

The findings highlight the double-edged nature of mass screening programs. On one hand, large-scale testing can uncover hidden cases, prevent long-term complications, and improve overall public health. On the other, identifying thousands of new patients means supporting them for life with specialized diets and medical follow-up, all of which adds substantial recurring costs.

The study suggests that the initial cost of screening is only the beginning. Once diagnosed, children require lifelong dietary adjustments, medical check-ups, and education to ensure compliance with a strict gluten-free diet. As more people are identified, these ongoing expenses accumulate year after year.

Balancing Cost, Benefit, and Feasibility

While the concept of universal screening for celiac disease is promising, the study stresses that its financial and organizational feasibility must be carefully evaluated. Policymakers will need to determine whether the benefits—such as earlier diagnosis and fewer complications—justify the high long-term costs.

Another concern is the impact on the healthcare system’s capacity. Adding widespread screening requires more laboratory facilities, trained personnel, and coordination between pediatricians, nutritionists, and diagnostic centers. Even if the program is well received by families, sustaining such an operation over time demands significant logistical planning.

Researchers also note that not all children diagnosed through mass screening may develop severe symptoms. Some could remain relatively healthy, raising questions about whether every positive result should lead to lifelong dietary restrictions. Further studies are needed to understand the long-term outcomes of “silent” or symptom-free cases.

Alternative Approaches

The study suggests that a more balanced strategy might combine targeted screening of high-risk groups with broader awareness campaigns rather than full population-wide testing. Targeted screening focuses on children who have related autoimmune conditions, family history of celiac disease, or signs of nutrient deficiency. This method may reduce costs while still capturing many undiagnosed cases.

The researchers emphasize that whichever approach is chosen, economic modeling is vital for responsible public health policy. Knowing the true costs and expected outcomes helps decision-makers design programs that are both effective and sustainable.

Conclusion: Why This Matters for Families with Celiac Disease

For families affected by celiac disease, Italy’s plan represents both opportunity and challenge. On the positive side, earlier detection can spare children years of unexplained illness and reduce the risk of serious complications later in life. Children diagnosed early can begin a gluten-free diet before major intestinal damage occurs, improving growth, development, and quality of life.

However, this study reminds us that early detection comes with significant long-term responsibilities. Healthcare systems must provide continuous dietary support, education, and medical follow-up to ensure children thrive on their gluten-free diet. Families must adjust daily routines, manage special food purchases, and remain vigilant about cross-contamination.

In the bigger picture, the study shows how investing in early detection can reshape the national conversation about celiac disease. By revealing how many children are silently affected, such programs raise awareness, promote better labeling and restaurant practices, and encourage research into easier treatments. But success will depend on careful planning, ongoing funding, and collaboration between health authorities, medical professionals, and the celiac community.

Read more at: sciencedirect.com