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
*“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.
II. Proposed Key Questions to Be Systematically Reviewed
- 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?
- 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?
- What are the harms of screening for celiac disease?
- What is the accuracy of screening tests for celiac disease?
- Does treatment of screen-detected celiac disease lead to improved morbidity, mortality, or quality of life compared with no treatment?
- Does treatment of screen-detected celiac disease lead to improved morbidity, mortality, or quality of life compared with treatment initiated after clinical diagnosis?
- 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.
- What is the prevalence of celiac disease in asymptomatic adolescents and adults in the United States?
- 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).
|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