Screening for Celiac Disease: A Systematic Review for the U.S. Preventive Services Task Force Agency for Healthcare Research and Quality U.S. Department of Health and Human Services

Agency for Healthcare Research and Quality U.S. Department of Health and Human Services.
Evidence Synthesis Number 144. AHRQ Publication No. 14-05215-EF-1. May 2016.

Background: Unrecognized celiac disease (CD) may have adverse effects on morbidity and mortality. Purpose: To review the evidence on screening for CD in asymptomatic adults, adolescents, and children 3 years of age and older for the United States Preventive Services Task Force.
Data Sources: Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to February 2016).
Study Selection: Randomized clinical trials, cohort studies, and case-control studies of screening versus no screening, one screening strategy versus another, treatment versus no treatment, or immediate versus delayed treatment that evaluated clinical outcomes; and studies on diagnostic accuracy of serological tests for CD.
Data Extraction: One investigator abstracted data, a second checked data for accuracy, and two investigators independently assessed study quality using predefined criteria. Data Synthesis (Results): We identified no trials of screening for CD. One recent, good-quality systematic review found serological tests to be accurate for diagnosing CD, but two studies conducted in asymptomatic populations reported lower sensitivity than in studies not restricted to asymptomatic populations. One fair-quality, small (n=40), Finnish treatment trial of screendetected, asymptomatic adults with positive serological findings found initiation of a gluten-free diet associated with small improvement in gastrointestinal symptoms versus no gluten-free diet (less than 1 point on a 1 to 7 scale) at 1 year, with no differences on most measures of quality of life. No withdrawals due to adverse events occurred during the trial.
Limitations: Limited or no evidence for all key questions; limited to English language studies. Conclusions: More research is needed to understand the effectiveness of screening and treatment for CD in asymptomatic adults, adolescents, and children; accuracy of screening tests; and optimal screening strategies.