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Screening for Celiac Disease: Evidence Report and Systematic Review for the US Preventive Services Task Force.

JAMA
January 1, 1970
Roger Chou et al. (6 authors)
Journal ArticleResearch Support, U.S. Gov't, P.H.S.ReviewSystematic ReviewHuman Study
Study Details

Study Goal

To review the evidence on benefits and harms of screening for celiac disease in asymptomatic individuals and assess the effectiveness of a gluten-free diet for screen-detected cases.

Results Summary

The study found that a gluten-free diet led to small improvements in gastrointestinal symptoms in asymptomatic adults with screen-detected celiac disease, but no significant differences in most quality-of-life measures. Diagnostic tests like IgA tissue transglutaminase showed high accuracy, but sensitivity was lower in asymptomatic populations.

Population

Asymptomatic adults, adolescents, and children 3 years and older.

Effective Dosage

Not specified

Duration

1 year

Interactions

None mentioned

Extracted Claims (6)
InterventionDirectionEndpointPopulationDosageImpactClaim #
IgA tissue transglutaminase test
increase
diagnosing celiac disease
participants in a systematic review of 56 original studies and 12 previous systematic reviews
sensitivity and specificity both >90%
was associated with high accuracy
#1
IgA endomysial antibodies tests
increase
diagnosing celiac disease
participants in a systematic review of 56 original studies and 12 previous systematic reviews
-
were associated with high specificity
#2
serologic tests for celiac disease
decrease
diagnosing celiac disease
asymptomatic populations
57% and 71%
reported lower sensitivity
#3
initiation of a gluten-free diet
increase
gastrointestinal symptoms
asymptomatic adults with screen-detected celiac disease
difference less than 1 point on a scale of 1 to 7
associated with small improvement
#4
initiation of a gluten-free diet
no change
quality of life
asymptomatic adults with screen-detected celiac disease
-
no differences on most measures
#5
gluten-free diet trial
no change
harms
asymptomatic adults with screen-detected celiac disease
-
no withdrawals due to adverse events occurred
#6
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.

Medical Subject Headings (MeSH)
AdolescentAdultAdvisory CommitteesAsymptomatic DiseasesCase-Control StudiesCeliac DiseaseChildChild, PreschoolDiet, Gluten-FreeGTP-Binding ProteinsHumansImmunoglobulin APreventive Health ServicesProtein Glutamine gamma Glutamyltransferase 2Quality of LifeSensitivity and SpecificityTransglutaminasesUnited States
Study Links
Quality Scores
Safety90
Efficacy40/10
Quality70/10
Citation Metrics
Total Citations58
Citations/Year7.3
Relative Citation Ratio3.25
NIH Percentile86.6%
Research Impact Scores
APT Score0.95
Weight Score1.73
Normalized Score0.66
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