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Draft Research Plan

Screening for Celiac Disease


Note: This is a draft Research Plan. This draft is distributed solely for the purpose of receiving public input. It has not been disseminated otherwise by the USPSTF.

The final Research Plan will be used to guide a systematic review of the evidence by researchers at an Evidence-based Practice Center. The resulting Evidence Review will form the basis of the USPSTF Recommendation Statement on this topic.

This draft Research Plan is available for comment from July 31 until August 27, 2014 at 5:00 p.m., ET. You may wish to read the entire Research Plan before you comment.


I. Proposed Analytic Framework

Select Text Description below for details.

*“Asymptomatic” persons are defined as those without known celiac disease and who have not sought evaluation for potential celiac disease; some asymptomatic persons may have mild nonspecific symptoms.

Abbreviations: GI = gastrointestinal; KQ = key question.

[D] Select for Text Description.

II. Proposed Key Questions to Be Systematically Reviewed

  1. What is the effectiveness of screening for celiac disease versus no screening in asymptomatic adults, adolescents, or children on morbidity, mortality, or quality of life?
  2. What is the effectiveness of targeted screening for celiac disease versus universal screening in asymptomatic adults, adolescents, or children on morbidity, mortality, or quality of life?
  3. What are the harms of screening for celiac disease?
  4. What is the accuracy of screening tests for celiac disease?
  5. Does treatment of screen-detected celiac disease lead to improved morbidity, mortality, or quality of life compared with no treatment?
  6. Does treatment of screen-detected celiac disease lead to improved morbidity, mortality, or quality of life compared with treatment initiated after clinical diagnosis?
  7. What are the harms associated with treatment for celiac disease?

III. Proposed Contextual Questions

Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.

  1. What is the prevalence of celiac disease in asymptomatic adolescents and adults in the United States?
  2. What is the natural history of subclinical or silent celiac disease?

IV. Proposed Research Approach

The Proposed Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions (KQs).

  Include Exclude
Populations KQs 1–4: Asymptomatic adults, adolescents, or children age 3 years and older without known celiac disease

KQs 5–7: Adults, adolescents, or children age 3 years and older with celiac disease

KQs 1–3: Symptomatic persons seeking evaluation for potential celiac disease
Interventions KQs 1–3: Serologic screening (IgA anti-tTG antibody or other commonly used tests)

KQ 4: Serologic screening (IgA anti-tTG antibody or other commonly used tests); questionnaires

KQs 5–7: Gluten-free diet

 
Comparators KQ 1: Screening vs. no screening

KQ 2: Targeted vs. universal screening

KQ 4: Endoscopy with biopsy

KQ 5: Screen-detected treatment vs. no treatment

KQ 6: Screen-detected celiac disease vs. disease detected after clinical diagnosis

 
Outcomes KQs 1, 2, 5, 6: Morbidity (including outcomes related to nutritional deficiencies), gastrointestinal outcomes (diarrhea, cramping, bloating, etc.), cancer incidence, child growth outcomes, infection rates, quality of life, etc.; mortality

KQ 3: Labeling, complications and harms from biopsy, overdiagnosis

KQ 4: Sensitivity, specificity, positive and negative predictive values, areas under the receiver operating curve, other measures of diagnostic test accuracy

KQ 7: Any harms of treatment

KQs 1, 2, 5, 6: Laboratory values for nutritional or other deficiencies
Settings KQs 1–3: Primary care KQs 1–3: Specialty clinics
Study designs KQs 1–3, 5–7: RCTs, controlled observational studies, and systematic reviews

KQ 4: Studies evaluating diagnostic accuracy of serologic screening or questionnaires compared with intestinal biopsy and systematic reviews

 

Abbreviations: IgA = immunoglobulin A; anti-tTG = anti-tissue transglutaminase; RCTs = randomized, controlled trials; vs = versus.

AHRQ Publication No. 14-05215-EF-5
Current as of July 2014


Internet Citation: U.S. Preventive Services Task Force. Screening for Celiac Disease: Draft Research Plan. AHRQ Publication No. 14-05215-EF-5. http://www.uspreventiveservicestaskforce.org/draftresplan3.htm



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