Thursday, 28 March, 2024
HomeGuidelinesNot enough evidence for guidance on celiac disease testing

Not enough evidence for guidance on celiac disease testing

There is not enough evidence to encourage or discourage doctors from testing all their patients for celiac disease, according to a US government-backed panel. Even when close relatives have been diagnosed with the autoimmune condition, there isn't enough evidence to say screening should always be done.

Reuters Health reports that the new statement from the US Preventive Services Task Force (USPSTF) applies to adults without celiac disease symptoms, which can include abdominal pain, bloating, gas, diarrhoea, anaemia and weight loss.

"I think if individuals are concerned or they’re having symptoms, they should talk to their doctor about it," said Dr Alex Krist, who is a USPSTF member and an associate professor of family medicine and population health at Virginia Commonwealth University in Richmond.

In people with celiac disease, consuming the gluten protein in wheat, rye or barley triggers an autoimmune response that harms the lining of the small intestine. As a result, people with the condition are advised to go on a gluten-free diet.

The USPSTF writes that between 0.40% and 0.95% of people in the US have celiac disease. The condition is more common among non-Hispanic whites, people with a family history of celiac disease and people with other autoimmune conditions, such as type 1 diabetes.

Recommendations of other organisations vary, but some – like the American College of Gastroenterology and the North American Society of Pediatric Gastroenterology – do recommend testing certain individuals who are at an increased risk for the condition.

Testing for celiac disease starts out with a blood sample, Krist said. If the blood test is positive, a biopsy of the small intestine may be needed to confirm the results. "We don’t want to subject patients to that type of test if it’s not going to help them," he said.

The USPSTF says more research on screening people at an increased risk of celiac disease who are not showing symptoms is needed. Additionally, Krist said, research is needed on the course of the disease among people living with the condition but not showing symptoms – known as silent or asymptomatic celiac disease.

In an editorial, Drs Rok Seon Choung and Joseph Murray from the Mayo Clinic in Rochester, Minnesota agree there is a lack of evidence supporting universal testing for celiac disease in people without symptoms.

"Recognising 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," they add.

Krist said the USPSTF regularly evaluates the evidence on its statements and recommendations. Depending on evidence, the statement may change during a future update. Until then, he said, people should bring up their concerns to their doctors.

Abstract
Importance: Celiac disease is caused by an immune response in persons who are genetically susceptible to dietary gluten, a protein complex found in wheat, rye, and barley. Ingestion of gluten by persons with celiac disease causes immune-mediated inflammatory damage to the small intestine.
Objective: To issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for celiac disease.
Evidence Review: The USPSTF reviewed the evidence on the accuracy of screening in asymptomatic adults, adolescents, and children; the potential 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 USPSTF also reviewed contextual information on the prevalence of celiac disease among patients without obvious symptoms and the natural history of subclinical celiac disease.
Findings: The USPSTF found inadequate evidence on the accuracy of screening for celiac disease, the potential benefits and harms of screening vs not screening or targeted vs universal screening, and the potential benefits and harms of treatment of screen-detected celiac disease.
Conclusions and Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for celiac disease in asymptomatic persons. (I statement)

Authors
US Preventative Task Force

[link url="http://www.reuters.com/article/us-health-celiac-recommendations-idUSKBN16Z2UE"]Reuters Health report[/link]
[link url="http://jamanetwork.com/journals/jama/fullarticle/2613172"]JAMA abstract[/link]
[link url="http://jamanetwork.com/journals/jama/fullarticle/2613135"]JAMA editorial[/link]
[link url="http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2611959"]JAMA Internal Medicine editorial[/link]

MedicalBrief — our free weekly e-newsletter

We'd appreciate as much information as possible, however only an email address is required.