No popular authors found.
Ads by Google:

Categories

No categories found.


Get Celiac.com's E-Newsletter





Ads by Google:


Follow / Share


  FOLLOW US:
Twitter Facebook Google Plus Pinterest RSS Podcast Email  Get Email Alerts
SHARE:

Popular Articles

No popular articles found.
Celiac.com Sponsors:

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.

Ads by Google:

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.

Source:

Celiac.com welcomes your comments below (registration is NOT required).












Related Articles



2 Responses:

 
Sarah
Rating: ratingfullratingfullratingfullratingfullratingfull Unrated
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
Rating: ratingfullratingfullratingfullratingfullratingfull Unrated
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.




Rate this article and leave a comment:
Rating: * Poor Excellent
Your Name *: Email (private) *:




In Celiac.com's Forum Now:


Sorry your not responding well I've been gluten free dairy free and soy free since january. I didnt notice ANY improvements until that lucky 6 montb Mark you hear about quite often. There is definitely truth to that time period. With that being said I too had alot of dizziness heart Palps panic a...

Yes, I have heard about mushrooms and possible gluten exposure is in the medium they are grown on that can be concerning. Plus, you are not supposed to really wash mushrooms, just brush them off per chefs. http://www.foodnetwork.com/how-to/articles/how-to-clean-and-store-mushrooms-a-step-...

Welcome! The best way to determine if you have celiac disease is to take a simple blood test, but you need to be consuming gluten daily. So, do not go gluten free before testing. http://www.cureceliacdisease.org/screening/ honestly, those allergy tests are not accurate. h...

He is a kid. Gluten may be still getting into his diet. That is why testing is critical. Now, more than ever, since he is a teen. I read in one celiac book, Gluten Freedom by Dr. Fasano, that one teen patient was getting sick. His parents were perplexed. Speaking to the doctor alone, th...

Good luck ill say a prayer. I try to zone out breath in and out slow. Ive had many procedures. Ice pack on wrist slows circulation. Think of flowers or the wind close your eyes and relax. Practice at home.