USPSTF Issues Recommendations for Celiac Disease Screening

The US Preventive Services Task Force (USPSTF) has concluded that current evidence is insufficient to recommend either for or against screening for celiac disease in asymptomatic individuals, according to a new recommendation statement. ¹

In order to issue a recommendation on screening for celiac disease, researchers from the USPSTF reviewed available evidence on the accuracy of screening in asymptomatic individuals, the potential benefits and harms of screening vs not screening, and the benefits and harms of treating screen-detected celiac disease in asymptomatic individuals.
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In an evidence report commissioned by the USPSTF, researchers analyzed data from a recent, good-quality systematic review of 56 original studies and 12 previous systematic reviews, which found that tissue transglutaminase IgA testing—the standard method for diagnosing celiac disease in symptomatic persons older than 2 years—was associated with high accuracy for diagnosing celiac disease. ² Two studies of serologic tests for celiac disease were conducted in asympotomatic individuals, which reported lower sensitivity than IgA endomysial antibodies tests. A small, 40-participant study of asymptomatic adults with screen-detected celiac disease found that initiation of a gluten-free diet was associated with small improvements in gastrointestinal symptoms.

However, “[a]lthough 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,” wrote the authors of the report.

Overall, the USPSTF concluded that current available evidence was insufficient to assess the benefits and harms of screening  for celiac disease in asymptomatic persons.

More information is needed, they wrote, on the accuracy of serologic testing in asymptomatic individuals, the effects of adherence to a gluten-free diet in asymptomatic individuals, outcomes in asymptomatic individuals at high risk of celiac disease who screen positive, and the natural history of positive serology in patients without histologic changes or with histologic confirmation but no symptoms.

—Michael Potts

References:

USPSTF. Screening for celiac disease: US Preventive Services Task Force recommendation statement. JAMA. 2017;317(12):1252-1257.

Chou R, Bougatsos C, Blazina I, et al. Screening for celiac disease: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2017;317(12):1258-1268.