Screening for Celiac Disease
Evidence Synthesis, No. 144
Authors
Investigators: Roger Chou, MD, Ian Blazina, MPH, Christina Bougatsos, MPH, Katherine Mackey, MD, Sara Grusing, BA, and Shelley Selph, MD, MPH.Affiliations
Structured Abstract
Background:
Unrecognized celiac disease may have adverse effects on morbidity and mortality.
Purpose:
To review the evidence on screening for celiac disease in asymptomatic adults, adolescents, and children age 3 years or older for the U.S. Preventive Services Task Force.
Data Sources:
Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to mid-June 2016).
Study Selection:
Randomized clinical trials, cohort studies, and case-control studies of screening versus no screening, one screening strategy versus another, treatment versus no treatment, or immediate versus delayed treatment that evaluated clinical outcomes; and studies on diagnostic accuracy of serologic tests for celiac disease.
Data Extraction:
One investigator abstracted data, a second checked data for accuracy, and two investigators independently assessed study quality using predefined criteria.
Data Synthesis (Results):
We identified no trials of screening for celiac disease. One recent, good-quality systematic review found serologic tests to be accurate for diagnosing celiac disease, but two studies conducted in asymptomatic populations reported lower sensitivity than in studies not restricted to asymptomatic populations. One fair-quality, small (n=40) Finnish treatment trial of screen-detected, asymptomatic adults with positive serologic findings found initiation of a gluten-free diet associated with small improvement in gastrointestinal symptoms versus no gluten-free diet (<1 point on a 7-point scale) at 1 year, with no differences on most measures of quality of life. No withdrawals due to adverse events occurred during the trial.
Limitations:
Limited or no evidence for all key questions; limited to English-language studies.
Conclusions:
More research is needed to understand the effectiveness of screening for and treatment of celiac disease in asymptomatic adults, adolescents, and children; accuracy of screening tests; and optimal screening strategies.
Suggested citation:
Chou R, Blazina I, Bougatsos C, Mackey K, Grusing S, Selph S. Screening for Celiac Disease: A Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 144. AHRQ Publication No. 14-05215-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2017.
This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (HHSA-290-2012-00015-I, Task Order No. 4). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.
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