The accuracy of diagnostic indicators for coeliac disease: A systematic review and meta-analysis

<h4>Background</h4> The prevalence of coeliac disease (CD) is around 1%, but diagnosis is challenged by varied presentation and non-specific symptoms and signs. This study aimed to identify diagnostic indicators that may help identify patients at a higher risk of CD in whom further testi...

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Autores principales:	Martha M. C. Elwenspoek, Joni Jackson, Rachel O’Donnell, Anthony Sinobas, Sarah Dawson, Hazel Everitt, Peter Gillett, Alastair D. Hay, Deborah L. Lane, Susan Mallett, Gerry Robins, Jessica C. Watson, Hayley E. Jones, Penny Whiting
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/91b8161063834f138bbc64e11479f338
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spelling	oai:doaj.org-article:91b8161063834f138bbc64e11479f3382021-11-04T06:09:16ZThe accuracy of diagnostic indicators for coeliac disease: A systematic review and meta-analysis1932-6203https://doaj.org/article/91b8161063834f138bbc64e11479f3382021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8545431/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4> The prevalence of coeliac disease (CD) is around 1%, but diagnosis is challenged by varied presentation and non-specific symptoms and signs. This study aimed to identify diagnostic indicators that may help identify patients at a higher risk of CD in whom further testing is warranted. <h4>Methods</h4> International guidance for systematic review methods were followed and the review was registered at PROSPERO (CRD42020170766). Six databases were searched until April 2021. Studies investigating diagnostic indicators, such as symptoms or risk conditions, in people with and without CD were eligible for inclusion. Risk of bias was assessed using the QUADAS-2 tool. Summary sensitivity, specificity, and positive predictive values were estimated for each diagnostic indicator by fitting bivariate random effects meta-analyses. <h4>Findings</h4> 191 studies reporting on 26 diagnostic indicators were included in the meta-analyses. We found large variation in diagnostic accuracy estimates between studies and most studies were at high risk of bias. We found strong evidence that people with dermatitis herpetiformis, migraine, family history of CD, HLA DQ2/8 risk genotype, anaemia, type 1 diabetes, osteoporosis, or chronic liver disease are more likely than the general population to have CD. Symptoms, psoriasis, epilepsy, inflammatory bowel disease, systemic lupus erythematosus, fractures, type 2 diabetes, and multiple sclerosis showed poor diagnostic ability. A sensitivity analysis revealed a 3-fold higher risk of CD in first-degree relatives of CD patients. <h4>Conclusions</h4> Targeted testing of individuals with dermatitis herpetiformis, migraine, family history of CD, HLA DQ2/8 risk genotype, anaemia, type 1 diabetes, osteoporosis, or chronic liver disease could improve case-finding for CD, therefore expediting appropriate treatment and reducing adverse consequences. Migraine and chronic liver disease are not yet included as a risk factor in all CD guidelines, but it may be appropriate for these to be added. Future research should establish the diagnostic value of combining indicators.Martha M. C. ElwenspoekJoni JacksonRachel O’DonnellAnthony SinobasSarah DawsonHazel EverittPeter GillettAlastair D. HayDeborah L. LaneSusan MallettGerry RobinsJessica C. WatsonHayley E. JonesPenny WhitingPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Martha M. C. Elwenspoek Joni Jackson Rachel O’Donnell Anthony Sinobas Sarah Dawson Hazel Everitt Peter Gillett Alastair D. Hay Deborah L. Lane Susan Mallett Gerry Robins Jessica C. Watson Hayley E. Jones Penny Whiting The accuracy of diagnostic indicators for coeliac disease: A systematic review and meta-analysis
description	<h4>Background</h4> The prevalence of coeliac disease (CD) is around 1%, but diagnosis is challenged by varied presentation and non-specific symptoms and signs. This study aimed to identify diagnostic indicators that may help identify patients at a higher risk of CD in whom further testing is warranted. <h4>Methods</h4> International guidance for systematic review methods were followed and the review was registered at PROSPERO (CRD42020170766). Six databases were searched until April 2021. Studies investigating diagnostic indicators, such as symptoms or risk conditions, in people with and without CD were eligible for inclusion. Risk of bias was assessed using the QUADAS-2 tool. Summary sensitivity, specificity, and positive predictive values were estimated for each diagnostic indicator by fitting bivariate random effects meta-analyses. <h4>Findings</h4> 191 studies reporting on 26 diagnostic indicators were included in the meta-analyses. We found large variation in diagnostic accuracy estimates between studies and most studies were at high risk of bias. We found strong evidence that people with dermatitis herpetiformis, migraine, family history of CD, HLA DQ2/8 risk genotype, anaemia, type 1 diabetes, osteoporosis, or chronic liver disease are more likely than the general population to have CD. Symptoms, psoriasis, epilepsy, inflammatory bowel disease, systemic lupus erythematosus, fractures, type 2 diabetes, and multiple sclerosis showed poor diagnostic ability. A sensitivity analysis revealed a 3-fold higher risk of CD in first-degree relatives of CD patients. <h4>Conclusions</h4> Targeted testing of individuals with dermatitis herpetiformis, migraine, family history of CD, HLA DQ2/8 risk genotype, anaemia, type 1 diabetes, osteoporosis, or chronic liver disease could improve case-finding for CD, therefore expediting appropriate treatment and reducing adverse consequences. Migraine and chronic liver disease are not yet included as a risk factor in all CD guidelines, but it may be appropriate for these to be added. Future research should establish the diagnostic value of combining indicators.
format	article
author	Martha M. C. Elwenspoek Joni Jackson Rachel O’Donnell Anthony Sinobas Sarah Dawson Hazel Everitt Peter Gillett Alastair D. Hay Deborah L. Lane Susan Mallett Gerry Robins Jessica C. Watson Hayley E. Jones Penny Whiting
author_facet	Martha M. C. Elwenspoek Joni Jackson Rachel O’Donnell Anthony Sinobas Sarah Dawson Hazel Everitt Peter Gillett Alastair D. Hay Deborah L. Lane Susan Mallett Gerry Robins Jessica C. Watson Hayley E. Jones Penny Whiting
author_sort	Martha M. C. Elwenspoek
title	The accuracy of diagnostic indicators for coeliac disease: A systematic review and meta-analysis
title_short	The accuracy of diagnostic indicators for coeliac disease: A systematic review and meta-analysis
title_full	The accuracy of diagnostic indicators for coeliac disease: A systematic review and meta-analysis
title_fullStr	The accuracy of diagnostic indicators for coeliac disease: A systematic review and meta-analysis
title_full_unstemmed	The accuracy of diagnostic indicators for coeliac disease: A systematic review and meta-analysis
title_sort	accuracy of diagnostic indicators for coeliac disease: a systematic review and meta-analysis
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/91b8161063834f138bbc64e11479f338
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The accuracy of diagnostic indicators for coeliac disease: A systematic review and meta-analysis

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