A report from Reuters states that draft guidelines presented by U.S. doctors say there isn’t enough evidence yet to prove that widespread screening for celiac disease is necessary.
Issued by the US Preventive Services Task Force, the draft concludes that more research should be conducted on the possible benefits of screening asymptomatic people, especially those with a heightened risk for celiac disease due to family histories or diabetes.
Dr. Alex Krist, a researcher from the Virginia Commonwealth University in Richmond, says in an email that, “In the face of unclear evidence, doctors should use their clinical judgment when deciding whom to screen. The Task Force encourages people with an increased risk of celiac disease to talk to their doctor about what tests are best for them.”
Data from the University of Chicago Celiac Disease Center says that around one in 133 Americans have celiac disease. The number rises to one in 22 among first-degree relatives of people diagnosed with it.
Celiac disease can be detected by a blood test, which shows antibodies that have an immune response to gluten. It may also be confirmed by doing a biopsy of the small intestines.
People diagnosed with celiac disease are often told to go for a gluten-free diet to prevent symptoms such as bloating, gas, diarrhea, abdominal pain, weight loss and anemia.
The USPSTF is a government-supported organization that reviews medical theories and evidence, issues recommendations under close supervision by doctors and nurses. This is the first announcement the group has made regarding celiac disease.
Krist noted that one concern with celiac screening is that biopsies still have risks, and may confirm the presence of celiac that does not necessarily require treatment. While the initial blood test is accessible and inexpensive, biopsies are needed to confirm celiac disease – these can get expensive and invasive.
Gastroenterologists usually recommend screening for people with first-degree relatives who have celiac or diabetes. Dr. Joseph Murray,director of the celiac disease program at the Mayo Clinic in Rochester, Minnesota and an author of celiac screening guidelines issued by the American College of Gastroenterology, points out that the most puzzling aspect of the USPSTF draft recommendations is that they did not address people with an increased risk.
“In my experience as a clinician, as well as some studies that have been undertaken, many of the individuals who are family members have symptoms, though they may not have complained of those symptoms to their doctors, sometimes because they did not realize they were an abnormality and sometimes because they were never asked,” Murray says.
Alice Bast, chief executive officer of Beyond Celiac, an organization for patient advocacy that helped with the USPSTF recommendations, says that a lack of evidence should not stop people from getting screened. “The risk posed by the potential long-term health complications far outweighs the inconvenience and potential downsides.”