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  • Scott Adams
    Scott Adams

    Who Should Get Screened for Celiac Disease?

    Reviewed and edited by a celiac disease expert.

    Who should get tested for celiac disease? The answers can vary, depending on who you ask.

    Who Should Get Screened for Celiac Disease? - Image: CC BY 2.0--National Eye Institute
    Caption: Image: CC BY 2.0--National Eye Institute

    Celiac.com 06/11/2020 - Who should get screened for celiac disease? Traditionally, doctors test for celiac disease, based on the following factors:

    • Signs and symptoms of malabsorption, including chronic diarrhea with weight loss, steatorrhea, abdominal pain after eating, and bloating, or:
    • Laboratory evidence of malabsorption, particularly in people who have a first-degree family member with a confirmed celiac disease diagnosis. This includes associated nutritional deficiencies, or:
    • A personal history of an autoimmune disease, or an IgA deficiency, or:
    • Biopsy-proven DH, iron-deficiency anemia refractory to oral supplementation, or hypertransaminasemia with no other origins.

    So who, exactly, should be screened for celiac disease?

    Celiac Disease Screening Recommendations per Organization:



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    The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN)
    Recommends celiac disease screening in asymptomatic children who have conditions associated with celiac disease, including type 1 diabetes mellitus, autoimmune thyroiditis, Down syndrome, Turner syndrome, Williams syndrome, selective IgA deficiency, and first-degree relatives of celiac patients. 

    It recommends testing asymptomatic children who are at risk beginning around age 3 years, provided they have had an adequate gluten-containing diet for at least 1 year before testing. It recommends that asymptomatic persons with negative serology who are at risk be considered for repeat testing.

    The American College of Gastroenterology 
    Recommends that asymptomatic persons with a first-degree relative who has a confirmed diagnosis of celiac disease be considered for testing. Patients with type 1 diabetes mellitus should be tested for celiac disease if there are any digestive symptoms, signs, or laboratory evidence suggestive of celiac disease.

    The U.K. National Institute for Health and Care Excellence 
    Recommends offering serologic testing for celiac disease to persons with a first-degree relative with celiac disease or persons with type 1 diabetes mellitus or autoimmune thyroid disease upon diagnosis. 

    They also recommend considering serologic celiac testing for persons with metabolic bone disorder (reduced bone mineral density or osteomalacia), unexplained neurologic symptoms (particularly peripheral neuropathy or ataxia), unexplained sub-fertility or recurrent miscarriage, persistently elevated liver enzymes with unknown cause, dental enamel defects, Down syndrome, or Turner syndrome.

    Based on more recent study data, many doctors are beginning to do celiac screening in patients with:

    Anemia
    A 2014 study showed that celiac disease is common in people with unexplained autism. The study team recommends celiac screening for anyone with unexplained iron-deficient anemia.

    Autism
    People with autism have celiac disease at rates almost 20 times higher than in those without autism, reported lead investigator Daniel Karb, MD, a second-year resident at University Hospitals Case Medical Center in Cleveland. As such, many doctors now recommend celiac screening for people with autism.

    Autoimmune Disorders
    Researchers urge primary care doctors to adopt a practice of celiac screening for all people with elevated risk factors, including people with a family history of celiac disease, people with Addison’s disease Down Syndrome type 1 diabetes, thyroiditis, Turner syndrome, and type 1 diabetes. The team also called for screening of patients with short stature, iron deficiency anemia, and high transaminase levels.

    First-degree Relatives of Celiacs
    A Mayo Clinic team found celiac disease in 160 of 360 first-degree relatives of celiac patients, while 62% of those relatives found to have celiac were women. Most doctors now recommend testing first degree relatives of celiac disease patients.

    IgA Deficiency
    The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition recommends testing for celiac disease in asymptomatic children who have conditions associated with celiac disease, including selective IgA deficiency.

    Unexplained Neuropathy
    Patients with unexplained neuropathy, or small fiber neuropathy should be screened for celiac disease and gluten-sensitivity, according to researchers.

    Consider Celiac Screening for Top Physical Complaints
    People with any one or more of the Ten Most Common Complaints of Celiac Patients, might want to consider the possibility of celiac disease, look for any other celiac-related symptoms, and consult a doctor if they suspect celiac disease. The ten most common physical complaints of people who have celiac disease are: Osteopenia/Osteoporosis; Anemia; Cryptogenic hypertransaminasemia; Diarrhea; Bloating; Aphthous stomatitis; Alternating bowel habit; Constipation; Gastroesophageal reflux disease and Recurrent miscarriages.

    Most People with Celiac Disease Show No Symptoms
    Remember that most people who are diagnosed with celiac disease show no symptoms at the time of their diagnosis.

    What's Involved in Celiac Disease Screening?
    Find out what's involved in screening and testing for celiac disease

    Edited by Scott Adams



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  • About Me

    Scott Adams

    Scott Adams was diagnosed with celiac disease in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. In 1995 he launched the site that later became Celiac.com to help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives.  He is co-author of the book Cereal Killers, and founder and publisher of the (formerly paper) newsletter Journal of Gluten Sensitivity. In 1998 he founded The Gluten-Free Mall which he sold in 2014. Celiac.com does not sell any products, and is 100% advertiser supported.


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  • Related Articles

    Jefferson Adams
    Celiac.com 01/14/2015 - Recent epidemiological studies show that celiac disease rates are still underestimated, both in Europe and in Mediterranean regions. But how is better testing impacting higher celiac numbers in Europe?
    To get a clearer picture, a team of researchers recently set out to review the latest data on celiac rates and incidence in the European Union (EU) as of September 2014.
    The research team included E. Altobelli, R. Paduano, R. Petrocelli, and F. Di Orio. They are variously affiliated with the Department of Life, Health and Environmental Sciences at the University of L'Aquila in L'Aquila, Italy, and with ASREM in Molise, Italy.
    They assessed the celiac disease rates and cases by conducting a search of PubMed for papers in English using the key words "celiac disease", "celiac disease plus prevalence" (limits: 1990-2014), "incidence" (limits: 1970-2014), and "frequency", plus "in Europe". They conducted additional searches using the same key words plus the name of each European country.
    The team included only prevalence data obtained by serology using anti-gliadin antibodies (AGA), EMA test, tTG test, and/or duodenal biopsy, and only studies that were retrospective and prospective, such as population-based, cross-sectional, case-control and cohort studies.
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    Considering data from different periods, incidence seems to range from 0.1 to 3.7/1000 live births in the child population and from 1.3 to 39/100,000/year in the adult population.
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    Jefferson Adams
    Celiac.com 09/30/2015 - In 2013, a team from the U.S. Food and Drug Administration conducted a survey of white and green teas, commercially available in the northeastern United States, for the presence of gluten in the form of undeclared wheat.
    The survey team included EA Garber, R Panda, and KF Shireen. They are variously affiliated with the Office of Regulatory Science, U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, and the Office of Compliance, U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition in College Park, Maryland, USA.
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    Source:
    J Food Prot. 2015 Jun;78(6):1237-43. doi: 10.4315/0362-028X.JFP-14-575.


    Jefferson Adams
    Celiac.com 04/25/2017 - A recent issue of JAMA, the US Preventive Services Task Force (USPSTF) critically examines screening for celiac disease in asymptomatic adults, adolescents, and children.
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    The also note the possibility that the rise in gluten-free dieting by people without an official celiac diagnosis might be an indication of the uncertainty of current screening and diagnostic approaches.
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    Jefferson Adams
    Celiac.com 07/03/2018 - The vast majority of celiac disease remain undiagnosed, and clinical testing is usually done on a case by case basis. Factor in vague or atypical symptoms, and you have a recipe for delayed diagnosis and unnecessary suffering. What determines who gets tested, and are current screening methods working?
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    Source:
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