title: Screening for Celiac Disease: Evidence Report and Systematic Review for the US Preventive Services Task Force.
abstract: Silent or subclinical celiac disease may result in potentially avoidable adverse health consequences.
  
  
  
  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.
  
  
  
  Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews, searched to June 14, 2016.
  
  
  
  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.
  
  
  
  One investigator abstracted data, a second checked data for accuracy, and 2 investigators independently assessed study quality using predefined criteria.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: The Pacific Northwest Evidence-based Practice Center, Departments of Medicine and Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland.
authors.forename: Roger
authors.initials: R
authors.lastname: Chou
authors.affiliation: The Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland.
authors.forename: Christina
authors.initials: C
authors.lastname: Bougatsos
authors.affiliation: The Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland.
authors.forename: Ian
authors.initials: I
authors.lastname: Blazina
authors.affiliation: Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland.
authors.forename: Katherine
authors.initials: K
authors.lastname: Mackey
authors.affiliation: The Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland.
authors.forename: Sara
authors.initials: S
authors.lastname: Grusing
authors.affiliation: The Pacific Northwest Evidence-based Practice Center, Departments of Family Medicine and Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland.
authors.forename: Shelley
authors.initials: S
authors.lastname: Selph
mesh_terms: D000293:Adolescent; D000328:Adult; D026683:Advisory Committees; D058070:Asymptomatic Diseases; D016022:Case-Control Studies; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy; D002648:Child; D002675:Child, Preschool; D055050:Diet, Gluten-Free; D019204:GTP-Binding Proteins / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D011314:Preventive Health Services; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011788:Quality of Life; D012680:Sensitivity and Specificity; D011503:Transglutaminases / Q000276:immunology; D014481:United States
chemical_list: D007070:Immunoglobulin A; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins