Background: Unrecognized celiac disease may have adverse effects on morbidity and mortality.
Purpose: To review the evidence on screening for celiac disease in asymptomatic adults, adolescents, and children age 3 years or older for the U.S. Preventive Services Task Force.
Data Sources: Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to mid-June 2016).
Study Selection: Randomized clinical trials, cohort studies, and case-control studies of screening versus no screening, one screening strategy versus another, treatment versus no treatment, or immediate versus delayed treatment that evaluated clinical outcomes; and studies on diagnostic accuracy of serologic tests for celiac disease.
Data Extraction: One investigator abstracted data, a second checked data for accuracy, and two investigators independently assessed study quality using predefined criteria.
Data Synthesis (Results): We identified no trials of screening for celiac disease. One recent, good-quality systematic review found serologic tests to be accurate for diagnosing celiac disease, but two studies conducted in asymptomatic populations reported lower sensitivity than in studies not restricted to asymptomatic populations. One fair-quality, small (n=40) Finnish treatment trial of screen-detected, asymptomatic adults with positive serologic findings found initiation of a gluten-free diet associated with small improvement in gastrointestinal symptoms versus no gluten-free diet (<1 point on a 7-point scale) at 1 year, with no differences on most measures of quality of life. No withdrawals due to adverse events occurred during the trial.
Limitations: Limited or no evidence for all key questions; limited to English-language studies.
Conclusions: More research is needed to understand the effectiveness of screening for and treatment of celiac disease in asymptomatic adults, adolescents, and children; accuracy of screening tests; and optimal screening strategies.