Screening for celiac disease: A USPSTF recommendation statement

The USPSTF evaluated the benefits and harms of screening vs not screening, targeted vs universal screening, and treatment for celiac disease.
The USPSTF evaluated the benefits and harms of screening vs not screening, targeted vs universal screening, and treatment for celiac disease.

Evidence is insufficient to assess the benefits and harms of  screening for celiac disease in asymptomatic adults, adolescents, and children, according to a statement from the US Preventive Services Task Force (USPSTF) that was published in JAMA.

The USPSTF evaluated the benefits and harms of screening vs not screening and targeted vs universal screening; and the benefits and harms of treatment of screen-detected celiac disease. The task force also reviewed contextual information on the prevalence of celiac disease among patients without obvious symptoms and the natural history of subclinical celiac disease.

The USPSTF found inadequate evidence on the effectiveness of screening for celiac disease in asymptomatic adults, adolescents, and children with regard to morbidity, mortality, or quality of life. The potential harms of screening for celiac disease in asymptomatic populations include false-positive, inconclusive, or unnecessary serologic test results and biopsies, with possible anxiety or complications from testing.

The USPSTF also found inadequate evidence on 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.

Treatment studies in screen-detected, asymptomatic persons are needed to understand the effects of adherence to a gluten-free diet (compared with no dietary intervention), as well as the effects of immediate vs delayed dietary changes (ie, at the time of screen-detected diagnosis vs when symptoms develop), according to the task force.

In an accompanying editorial, Rok Seon Choung, MD, and Joseph A. Murray, MD, wrote: “In summary, current evidence on the effectiveness of screening for celiac disease in asymptomatic populations is scarce or absent and certainly insufficient to recommend for or against screening, as indicated in the USPSTF Recommendation Statement. Recognizing that most celiac disease is undetected and may present with diverse symptoms, it is reasonable that clinicians should have a low threshold for testing for celiac disease, especially in high-risk populations such as those with an affected family member or type 1 diabetes mellitus. In all patients, a family history of celiac disease should be routinely sought, given the influence on disease risk.”

In a second editorial, Nicholas J. Talley, MD, PhD, FRACP, and Marjorie M. Walker, BMedSci, BMBS, FRCPath, FRCPA, stated, “In the right clinical setting, symptomatic celiac disease is treatable, but we do not recommend population screening. Further data on the clinical impact of a gluten-free diet on the microbiome and the long-term health consequences in those without celiac disease are needed. The entity nonceliac gluten or wheat sensitivity closely overlaps with the functional gastrointestinal disorders, and new evidence suggests that at least in some gluten may not be the culprit despite symptom improvement after beginning a gluten-free diet. We do not recommend a lifelong gluten-free diet for individuals without celiac disease.”

References

  1. Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for celiac disease: US preventive services task force recommendation statement. JAMA. 28 March 2017. doi: 10.1001/jama.2017.1462
  2. Choung RS, Murray JA. The US Preventive Services Task Force Recommendation on screening for asymptomatic celiac disease: A dearth of evidence. JAMA. 28 March 2017. doi: 10.1001/jama.2017.1105
  3. Talley NJ, Walker MM. Celiac disease and nonceliac gluten or wheat sensitivity: The risks and benefits of diagnosis. JAMA Intern Med. 28 March 2017. doi: 10.1001/jamainternmed.2017.0695
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