Screening for Celiac Disease

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 studies met 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 evidence was 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.

Value of routine duodenal mucosal biopsies in the evaluation of anemia in a large Australian referral centre

“…According to our study, this approach can successfully exclude celiac disease in >99% of patients. Previous studies have shown that the sensitivity and specificity of anti‐TTG are 85–95% . While the sensitivity of anti‐TTG was only 80% in our study, this was likely due to a small sample size of patients with celiac disease and, therefore, increased variability of results.…”

“…There have also been advances made in serological screening and endoscopic imaging in the evaluation of celiac disease. In particular, with the use of antitissue transglutaminase antibody (anti‐TTG) and the assessment of total IgA levels (to exclude total IgA deficiency), celiac disease can be detected in up to 95% of patients . As a result, many guidelines suggested that negative serology may be sufficient to exclude celiac disease where the pretest probability is low .…”

The Value of Screening for Celiac Disease in Systemic Lupus Erythematosus: A Single Experience of a Tertiary Medical Center

“…The occurrence of CD was high among autoimmune disease patients. The prevalence of CD varies among SLE patient groups; several reports showed a greater coexistence of CD among patients with SLE than among their matched controls [ 29 , 31 ]. There is similarity between the pathogenesis of CD and SLE, as both share a common genetic predilection favored by the presence of HLAB8 and HLA DR3 [ 15 ].…”

Luminal Clinical

“…Background : Gastroscopy is frequently performed for investigation of unexplained anemia, and small bowel biopsy (SBBx) is routinely recommended to exclude celiac disease. This approach may not be cost‐effective, given increasing evidence that celiac serology and advanced endoscopic imaging may be sufficiently sensitive to exclude celiac disease …”