USPSTF: Insufficient evidence for celiac disease screening

There is a lack of current evidence to determine the balance of benefits and harms of screening for celiac disease in all asymptomatic adults, adolescents and children, according to a report issued by the U.S. Preventive Services Task Force.

“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,” Roger Chou, MD, The Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, and colleagues wrote. “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.”

The I-grade statement, published in JAMA, was based on a systematic review of three primary studies and one systematic review. According to the USPSTF, this review found inadequate evidence on:

the harms of screening for or treatment of celiac disease;
the accuracy of screening for celiac disease in asymptomatic adults, adolescents and children with regards to morbidity, mortality or quality of life;
the effectiveness of treatment of screen-detected, asymptomatic celiac disease to improve morbidity, mortality or quality of life compared with no treatment or treatment initiated after clinical diagnosis; and
the effectiveness of singling out those at increased risk for celiac disease for targeted screening.

According to researchers, the USPSTF recommendation parallels that of the AAFP. In addition, researchers wrote that the American College of Gastroenterology recommends that asymptomatic persons with a first-degree relative who is confirmed to have celiac disease be considered for testing and that patients with type 1 diabetes mellitus should be tested for celiac disease if there is laboratory evidence, signs or any digestive symptoms that suggest celiac disease.

In a related editorial, Rok Seon Choung, MD and Joseph A. Murray, MD, hepatology and gastroenterology division, Mayo Clinic, Rochester, Minnesota, wrote that the dearth of evidence on celiac disease presents an opportunity.

“As the trend towards less invasive testing and more ready access to a gluten-free diet reduces the burden of diagnosis and treatment, it behooves the medical research community to provide the data to determine who should be screened and treated for celiac disease, and when and how,” they wrote. “This will require carefully crafted and ambitious studies to address this question in high-risk groups as well as the general population, which includes most persons with undetected disease.”

According to the USPSTF, celiac disease occurs in 0.4% to 0.95% of adults in the U.S., with the frequency of the disease higher in persons with other autoimmune conditions, a family history of celiac disease, and non-Hispanic whites. – by Janel Miller

Disclosure: Chou reports no relevant financial disclosures.

References:

Chou R, et al. JAMA. 2017;doi:10.1001/jama.2016.10395.

Choung, R, Murray JA. JAMA. 2017;doi:10.1001/jama.2017.1105.

USPSTF. JAMA. 2017;doi:10.1001/jama.2017.1462.