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  • Jefferson Adams
    Jefferson Adams

    Should Doctors Bother Screening for Asymptomatic Celiac Disease?

    Reviewed and edited by a celiac disease expert.

    With scant evidence to show effectiveness, should doctors even bother screening for asymptomatic celiac disease?

    Should Doctors Bother Screening for Asymptomatic Celiac Disease? - Photo: CC--Quinn Dombrowski
    Caption: Photo: CC--Quinn Dombrowski

    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.

    Celiac disease exhibits a broad spectrum of symptoms, from subtle or no symptoms to severe malabsorption. Celiac diagnoses have increased significantly over the past few decades, in part because of greater awareness, but possibly because of an actual increase in disease rates. Researchers estimate current rates of celiac disease at 0.71% among US adults, and 0.76% among US children.

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    However, most celiac disease in the population remains undetected, despite wide availability of accurate serologic tests. Screening may be a good way to detect the disease, especially in people who have known risk factors, but have not yet developed symptoms. Noting a profound lack of supporting evidence in the medical literature, the USPSTF states bluntly that "the current evidence is insufficient to assess the balance of benefits and harms of screening for celiac disease in asymptomatic persons." The group recommends more research in this area.

    USPSTF admits its review of this topic might be criticized as premature, but emphasizes the need for data to provide direction with regards to best practices. The group used rigorous methodology to assess the effectiveness of celiac disease screening in an asymptomatic population, and found the resulting evidence to be thin in inconclusive. Their conclusion and recommendation will likely disappoint numerous clinicians, and more than a few patients.

    By design, the task force focuses solely on asymptomatic persons, or persons with unrecognized symptoms. They note that screening the general population could potentially detect not only asymptomatic patients, but also patients who lack typical symptoms such as weight loss, diarrhea, or malabsorption.

    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.

    Remember, the USPSTF is not anti-screening, they are pro-screening evidence. Since most celiac disease is undetected, and may present with variable symptoms, the group states that 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."

    Clinicians should routinely seek information on the patient’s family history of celiac disease.

    As celiac testing becomes easier and cheaper, and as gluten-free food becomes more available, it becomes more important for researchers provide the data to determine the best practices for screening and treating celiac disease.

    They stress the need for more comprehensive studies to assess best celiac screening practices in both high-risk groups, and in the general population, which includes most people with undetected celiac disease.

    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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    Guest Sarah

    Posted

    I am an asymptomatic celiac and IGA deficient. My doctor screened me when my daughter was diagnosed in 2008 and then re-tested 3 years later to re-check and called because Igg levels were abnormal but thought that could be anything. It turned out when I went to the celiac clinic that the 2008 test was also positive for celiac but the lab didn't label it correctly. Celiac center said that labs often do not correctly flag results and family physicians aren't trained well on the markers which can vary. They retested me for a different anti-body and then followed up with a positive biopsy. I think if they were to implement wide spread testing then this issue of consistent labs and training of physicians to interpret should be done first. Even a regular GI doctor I saw had to look up the blood tests on google. One other thing is I've observed anecdotally that many people tell me they're on a self-subscribed or doctor-recommended gluten free diet but don't have celiac because their doctor said they don't even though the doctor did no testing for antibodies, but simply told them since they had minimal symptoms they had gluten intolerance. I think that since the screening test for Celiac is a simple blood test that all doctors should recommend this before recommending a gluten free or reduced diet for patients.

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    Guest Alli

    My Kids' pedi won't test either because "they show no symptoms." Needless to say I'm on the hunt for a new pedi.

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    Guest Jean

    I was diagnosed 34 years ago. Last thing in a range of possibilities for which I was tested. No blood test back then.

    Two things- Drs find it easy to treat patients with drugs or other methods but telling people to give up bread? Shock, horror! Second point, we all know how hard it is to get close relatives to get tested because they might have to give up bread! No thought given to the consequences of continuing to consume gluten. Just don’t want know. If there was a pill, many more silent celiacs would be diagnosed.

    Having a conversation about testing family members is a sure conversation stopper in many cases. Concern for the health of family members is often seen as trying to ‘recruit’ to the ‘club’. I no longer bother even though I have many years involvement in celiac organizations and support group in two countries. 
     

    I have 4 related-by-marriage relatives (a brother and sister, and a father and daughter) who have been diagnosed with Celiac Disease. In each pair, one was symptomatic. So it took a while for the non- symptomatic one to get tested after the diagnosis of the other person. Both symptomatic persons had been ill for many years.  This example also emphasizes the possible numbers of undiagnosed Celiacs.  

    I am over simplifying the issue but basically it comes down to resistance from the medical profession,  and the people who should be tested. The blood test has been an great step forward but if only it is used. 
     

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  • About Me

    Jefferson Adams

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University. His articles, essays, poems, stories and book reviews have appeared in numerous magazines, journals, and websites, including North American Project, Antioch Review, Caliban, Mississippi Review, Slate, and more. He is the author of more than 2,500 articles on celiac disease. His university coursework includes studies in science, scientific methodology, biology, anatomy, physiology, medicine, logic, and advanced research. He previously devised health and medical content for Colgate, Dove, Pfizer, Sharecare, Walgreens, and more. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of numerous books, including "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

    >VIEW ALL ARTICLES BY JEFFERSON ADAMS

     


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