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Should Doctors Bother Screening for Asymptomatic Celiac Disease?

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


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.

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.

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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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2 Responses:

 
Sarah
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said this on
02 May 2017 8:16:10 AM PDT
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.

 
Alli
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said this on
11 Jun 2017 10:07:57 PM PDT
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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