The U.S. Preventative Services Task Force (USPSTF) has posted its research plan for the screening of the U.S. population for celiac disease. The research plan is designed to answer seven key questions about screening. These questions are:
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What is the effectiveness of screening versus not screening for celiac disease in asymptomatic adults, adolescents, or children on morbidity, mortality, or quality of life?
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What is the effectiveness of targeted* versus universal screening for celiac disease in asymptomatic adults, adolescents, or children on morbidity, mortality, or quality of life?
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What are the harms of screening for celiac disease?
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What is the accuracy of screening tests for celiac disease?
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Does treatment of screen-detected celiac disease lead to improved morbidity, mortality, or quality of life compared with no treatment?
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Does treatment of screen-detected celiac disease lead to improved morbidity, mortality, or quality of life compared with treatment initiated after clinical diagnosis?
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What are the harms associated with treatment of celiac disease?
*Targeted screening refers to testing in patients with a family history or other risk factors for celiac disease.
With these seven questions answered, the USPSTF will be able to make its judgement on if and how a general screening for celiac disease should take place in the US population. To answer these questions, research articles with specific criteria will be reviewed, as outlined in the following table.
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Include |
Exclude |
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Populations |
KQs 1–3: Asymptomatic adults, adolescents, or children age ≥3 years without known celiac disease who have not sought evaluation for potential celiac disease; some “asymptomatic” individuals may have mild, nonspecific symptoms. Studies of asymptomatic patients at higher risk (including patients with type 1 diabetes) will be included KQ 4: Asymptomatic adults, adolescents, or children age ≥3 years without known celiac disease. Studies of asymptomatic patients at higher risk (including patients with type 1 diabetes) will be included KQs 5–7: Patients with screen-detected celiac disease; if evidence in such patients is unavailable or very limited, patients with mild celiac disease will be included. Studies of asymptomatic patients at higher risk (including patients with type 1 diabetes) will be included |
KQs 1–3:Symptomatic persons seeking evaluation for potential celiac disease |
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Interventions |
KQs 1, 2: Serologic screening (immunoglobulin A [IgA] anti-tissue transglutaminase [TTG] antibody or other commonly used tests) KQ 3: Serologic screening (IgA TTG antibody or other commonly used tests); diagnostic testing, with or without biopsy KQ 4: Serologic screening (IgA TTG antibody or other commonly used tests); questionnaires KQs 5–7: Gluten-free diet |
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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 |
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Outcomes |
KQs 1, 2, 5, 6: Morbidity (including outcomes related to nutritional deficiencies, such as symptomatic or severe anemia [i.e., requiring treatment]), gastrointestinal outcomes (e.g., diarrhea, cramping, bloating), cancer incidence, mood and anxiety disorders, child growth outcomes, infection rates, and quality of life; mortality KQ 3: Labeling, complications/harms from workup/biopsy, and overdiagnosis KQ 4: Sensitivity, specificity, positive and negative predictive values, area under the receiver operating curve, and other measures of diagnostic test accuracy KQ 7: Any harms of treatment |
KQs 1, 2, 5, 6:Laboratory values for nutritional or other deficiencies |
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Settings |
KQs 1–3: Primary care |
KQs 1–3: Specialty clinics |
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Study designs |
KQs 1–3, 7: Randomized, controlled trials; controlled observational studies; systematic reviews KQ 4: Studies evaluating diagnostic accuracy of serologic screening or questionnaires compared with intestinal biopsy; systematic reviews KQs 5, 6: Randomized, controlled trials; systematic reviews |
KQ 4: Case-control studies |
Once the review of evidence is complete, the USPSTF will give its recommendation on the matter. The USPSTF posted this update to their research plan here in November, 2014, after a period of public comment ending in August.