![]() In a higher-risk population, the positive predictive value is 40% to 80%, depending on the serologic test used and whether the assumed prevalence is 5% or 10%. Based on estimated likelihood ratios in the general population, 2 the positive predictive value of serologic testing for celiac disease is 12% to 40%, assuming a prevalence of approximately 1%. Potential harms of screening for celiac disease in asymptomatic populations include false-positive, inconclusive, or unnecessary serologic test results and biopsies, with possible anxiety or complications from testing. 15 - 17 Reported prevalence among racial/ethnic minorities is lower than among non-Hispanic whites. 14 Several specialty societies recommend screening in these populations. Persons at increased risk for celiac disease include those who have a positive family history (eg, a first- or second-degree relative), with an estimated prevalence of 5% to 20%, 13 and persons with other autoimmune diseases (eg, type 1 diabetes mellitus, inflammatory luminal gastrointestinal disorders, Down syndrome, Turner syndrome, IgA deficiency, and IgA nephropathy). Three long-term studies of US adults with follow-up ranging from 10 to 45 years reported rates of progression from positive serology findings to clinical diagnosis of celiac disease of 0% to 15%. 8, 9 Data are limited on the proportion of persons with silent celiac disease (positive histology findings but no symptoms) or potential celiac disease (positive serology findings but mild or no intestinal damage on biopsy) who later develop symptomatic celiac disease. ![]() Data suggest that the average age at diagnosis is now in the fourth to sixth decade of life. Seroconversion to antibodies associated with celiac disease may occur at any time, and disease progression can take months or years, if it occurs at all. 1Ĭeliac disease affects children, adolescents, and adults. However, in a systematic review of 38 studies from North America and Western Europe, prevalence of celiac disease was similar among studies that included biopsy confirmation (0.15%-1.90%) and among studies that did not include biopsy confirmation (0.15%-2.70%). 2 For example, some population-based studies on prevalence rely on serologic testing without histologic confirmation, which may result in false-positive diagnoses and overestimate prevalence. 1 Some variations in prevalence can be attributed in part to the method used to confirm diagnosis. In 3 US-based studies, the prevalence of laboratory-confirmed celiac disease ranged from 0.40% to 0.95% among adults. 4 Evidence also suggests that celiac disease is associated with excess mortality, intestinal adenocarcinoma, and lymphoma however, evidence is insufficient as to whether silent, or asymptomatic, disease has the same risk as symptomatic disease. 3 Data from the United States suggest that some patients may have symptoms for years before being diagnosed. It may also manifest as nonspecific, nongastrointestinal symptoms, including anemia, osteoporosis, chronic fatigue, peripheral neuropathy or ataxia, and short stature. Quiz Ref ID Classic celiac disease is associated with symptoms of malabsorption, including diarrhea, abdominal pain, and weight loss. The USPSTF also reviewed contextual information on the prevalence of celiac disease among patients without obvious symptoms and the natural history of subclinical celiac disease.įindings The USPSTF found inadequate evidence on the accuracy of screening for celiac disease, the potential benefits and harms of screening vs not screening or targeted vs universal screening, and the potential benefits and harms of treatment of screen-detected celiac disease.Ĭonclusions and Recommendation The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for celiac disease in asymptomatic persons. Objective To issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for celiac disease.Įvidence Review The USPSTF reviewed the evidence on the accuracy of screening in asymptomatic adults, adolescents, and children the potential benefits and harms of screening vs not screening and targeted vs universal screening and the benefits and harms of treatment of screen-detected celiac disease. Ingestion of gluten by persons with celiac disease causes immune-mediated inflammatory damage to the small intestine. Importance Celiac disease is caused by an immune response in persons who are genetically susceptible to dietary gluten, a protein complex found in wheat, rye, and barley. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience. ![]()
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