Universal celiac testing lacks evidence - US panel

Last Updated: 2017-03-28

By Andrew M. Seaman

(Reuters Health) - There is not enough evidence to encourage or discourage universal screening for celiac disease in asymptomatic adults, according to a U.S. government-backed panel.

Even when close relatives have been diagnosed with the autoimmune condition, there isn't enough evidence to say screening should always be done, according to the U.S. Preventive Services Task Force (USPSTF).

Recommendations of other organizations vary, but some - like the American College of Gastroenterology and the North American Society of Pediatric Gastroenterology - do recommend testing certain individuals who are at an increased risk for the condition.

On behalf of the USPSTF, Dr. Alex Krist of Virginia Commonwealth University in Richmond and colleagues pointed out March 28 online in JAMA that if blood testing for celiac disease autoantibodies is positive, a biopsy of the small intestine may be needed to confirm the results.

"We don’t want to subject patients to that type of test if it’s not going to help them," he said.

The USPSTF says more research on screening people at an increased risk of celiac disease who are not showing symptoms is needed.

Additionally, Krist said, research is needed on the course of the disease among people with silent or asymptomatic celiac disease.

In an editorial, Drs. Rok Seon Choung and Joseph Murray from the Mayo Clinic in Rochester, Minnesota agree there is a lack of evidence supporting universal testing for celiac disease in people without symptoms.

But, they add, "Recognizing that most celiac disease is undetected and may present with diverse symptoms, 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."

The new statement was previously published as a draft in May 2016.

SOURCE: http://bit.ly/2o3i68e, http://bit.ly/2o3zBFx and http://bit.ly/2o3tWPY

JAMA 2017.