Screening for celiac disease

Evidence report and systematic review for the US Preventive Services Task Force

Roger Chou, Christina Bougatsos, Ian Blazina, Katherine Mackey, Sara Grusing, Shelley Selph

Research output: Contribution to journalReview article

22 Citations (Scopus)

Abstract

IMPORTANCE Silent or subclinical celiac disease may result in potentially avoidable adverse health consequences. OBJECTIVE To review the evidence on benefits and harms of screening for celiac disease in asymptomatic adults, adolescents, and children 3 years and older for the US Preventive Services Task Force. DATA SOURCES Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews, searched to June 14, 2016. STUDY SELECTION Randomized clinical trials and cohort or case-control studies on clinical benefits and harms of screening vs no screening for celiac disease or treatment vs no treatment for screen-detected celiac disease; studies on diagnostic accuracy of serologic tests for celiac disease. DATA EXTRACTION AND SYNTHESIS One investigator abstracted data, a second checked data for accuracy, and 2 investigators independently assessed study quality using predefined criteria. MAIN OUTCOMES AND MEASURES Cancer incidence, gastrointestinal outcomes, psychological outcomes, child growth outcomes, health outcomes resulting from nutritional deficiencies, quality of life, mortality, and harms of screening. No meta-analytic pooling was done. RESULTS One systematic review and 3 primary studiesmet inclusion criteria. No trials of screening for celiac disease were identified. One recent, good-quality systematic review of 56 original studies and 12 previous systematic reviews (sample sizes of primary studies ranging from 62 to more than 12 000 participants) found IgA tissue transglutaminase was associated with high accuracy (sensitivity and specificity both >90%) for diagnosing celiac disease. IgA endomysial antibodies tests were associated with high specificity. Only 2 studies of serologic tests for celiac disease involving 62 and 158 patients were conducted in asymptomatic populations and reported lower sensitivity (57%and 71%). One fair-quality, small (n = 40) Finnish treatment trial of asymptomatic adults with screen-detected celiac disease based on positive serologic findings found initiation of a gluten-free diet associated with small improvement in gastrointestinal symptoms compared with no gluten-free diet (difference less than 1 point on a scale of 1 to 7) at 1 year, with no differences on most measures of quality of life. No withdrawals due to adverse events occurred during the trial; no other harms were reported. No studies were identified that addressed the other outcomes. CONCLUSIONS AND RELEVANCE Although some evidencewas found regarding diagnostic accuracy of tests for celiac disease, little or no evidence was identified to inform most of the key questions related to benefits and harms of screening for celiac disease in asymptomatic individuals. More research is needed to understand the effectiveness of screening and treatment for celiac disease, accuracy of screening tests in asymptomatic persons, and optimal screening strategies.

Original languageEnglish (US)
Pages (from-to)1258-1268
Number of pages11
JournalJAMA - Journal of the American Medical Association
Volume317
Issue number12
DOIs
StatePublished - Mar 28 2017

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Celiac Disease
Advisory Committees
Gluten-Free Diet
Serologic Tests
Immunoglobulin A
Quality of Life
Research Personnel
Gastrointestinal Neoplasms
Health
Routine Diagnostic Tests
MEDLINE
Malnutrition
Sample Size
Case-Control Studies
Therapeutics
Randomized Controlled Trials
Databases
Psychology

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Screening for celiac disease : Evidence report and systematic review for the US Preventive Services Task Force. / Chou, Roger; Bougatsos, Christina; Blazina, Ian; Mackey, Katherine; Grusing, Sara; Selph, Shelley.

In: JAMA - Journal of the American Medical Association, Vol. 317, No. 12, 28.03.2017, p. 1258-1268.

Research output: Contribution to journalReview article

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abstract = "IMPORTANCE Silent or subclinical celiac disease may result in potentially avoidable adverse health consequences. OBJECTIVE To review the evidence on benefits and harms of screening for celiac disease in asymptomatic adults, adolescents, and children 3 years and older for the US Preventive Services Task Force. DATA SOURCES Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews, searched to June 14, 2016. STUDY SELECTION Randomized clinical trials and cohort or case-control studies on clinical benefits and harms of screening vs no screening for celiac disease or treatment vs no treatment for screen-detected celiac disease; studies on diagnostic accuracy of serologic tests for celiac disease. DATA EXTRACTION AND SYNTHESIS One investigator abstracted data, a second checked data for accuracy, and 2 investigators independently assessed study quality using predefined criteria. MAIN OUTCOMES AND MEASURES Cancer incidence, gastrointestinal outcomes, psychological outcomes, child growth outcomes, health outcomes resulting from nutritional deficiencies, quality of life, mortality, and harms of screening. No meta-analytic pooling was done. RESULTS One systematic review and 3 primary studiesmet inclusion criteria. No trials of screening for celiac disease were identified. One recent, good-quality systematic review of 56 original studies and 12 previous systematic reviews (sample sizes of primary studies ranging from 62 to more than 12 000 participants) found IgA tissue transglutaminase was associated with high accuracy (sensitivity and specificity both >90{\%}) for diagnosing celiac disease. IgA endomysial antibodies tests were associated with high specificity. Only 2 studies of serologic tests for celiac disease involving 62 and 158 patients were conducted in asymptomatic populations and reported lower sensitivity (57{\%}and 71{\%}). One fair-quality, small (n = 40) Finnish treatment trial of asymptomatic adults with screen-detected celiac disease based on positive serologic findings found initiation of a gluten-free diet associated with small improvement in gastrointestinal symptoms compared with no gluten-free diet (difference less than 1 point on a scale of 1 to 7) at 1 year, with no differences on most measures of quality of life. No withdrawals due to adverse events occurred during the trial; no other harms were reported. No studies were identified that addressed the other outcomes. CONCLUSIONS AND RELEVANCE Although some evidencewas found regarding diagnostic accuracy of tests for celiac disease, little or no evidence was identified to inform most of the key questions related to benefits and harms of screening for celiac disease in asymptomatic individuals. More research is needed to understand the effectiveness of screening and treatment for celiac disease, accuracy of screening tests in asymptomatic persons, and optimal screening strategies.",
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