What are the benefits and harms of screening for celiac disease in asymptomatic adults, adolescents, and children 3 years and older?

The United States Preventive Services Task Force (USPSTF) concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for celiac disease in asymptomatic adults, adolescents, and children 3 years or older (I statement). This statement also applies to targeting screening for persons who are at increased risk for celiac disease. (LOE = 2c)

Bibbins-Domingo K; US Preventive Services Task Force. Screening for celiac disease. US Preventive Services Task Force recommendation statement. JAMA 2017;317(12):1252-1257.  [PMID:28350936]

Practice guideline

Government

Population-based

In this review the USPSTF found insufficient evidence to assess the balance of benefits and harms of screening for celiac disease in asymptomatic adults, adolescents, and children aged 3 years and older. In addition the USPSTF also found inadequate evidence on targeted screening for persons at increased risk (eg, those with family history or other risk factors, including type 1 diabetes or other autoimmune disorders). There are no randomized controlled trials or controlled observational studies that have evaluated the effectiveness of screening versus no screening on patient-oriented clinical outcomes. In particular, no studies evaluated the value of early diagnosis and treatment of screen-detected, asymptomatic celiac disease compared with the diagnosis and treatment of symptomatic disease. The USPSTF also found no direct evidence regarding the harms of screening, including quantifying the amount of anxiety or unnecessary testing associated with false-positive results. The American Academy of Family Physicians also states that current evidence is insufficient to asses the balance of benefits and harms of screening for celiac disease in asymptomatic persons. The American College of Gastroenterology recommends that asymptomatic patients with a first-degree relative be considered for screening, as well as patients with type 1 diabetes if they have signs, symptoms, or laboratory evidence suggestive of celiac disease.