Who to screen and how to screen for celiac disease

Table 1 The pooled prevalence of celiac disease in various conditions

Condition	Pooled prevalence (%)	95%CI
Definite indications
Chronic diarrhea[18]a	3-10	NA
Iron deficiency anemia[14]	3.2	2.6-3.9
Short stature[32]
All-cause	7.4	4.7-10.6
Idiopathic	11.6	4.1-22.2
Type 1 diabetes[33]	6	5-6.9
Pediatric age group	6.2	6.1-6.3
Adults	2.7	2.1-2.3
First-degree relatives[37]	7.5	6.3-8.8
Dermatitis herpetiformis[45,46]a	9.8-17	NA
Down syndrome[47]	5.8	4.7-7.2
Probable indications
Cryptogenic hypertransaminesemia[48]	5.9	3.1-9.34
Autoimmune hepatitis[56]	3.5	1.6-5.3
Irritable bowel syndrome[57]	3.3	2.3-4.5
Diarrhea predominant IBS	5.4	3.3-7.8
Constipation predominant IBS	1.8	0.9-3.0
Mixed-IBS	3.1	1.7-5.1
Osteoporosis[64]	1.6	1.1-2.0
Possible indications
Dyspepsia[65]	1.4	0.9-1.8
Women with infertility[73]
All-cause infertility	0.7	0.2-1.2
Idiopathic infertility	0.6	0.0-1.6
Idiopathic cardiomyopathy[74-78]a	0-5.7
Autoimmune thyroid disease[79]	1.6	1.3-1.9
Hypothyroidism	1.4	1-1.9
Hyperthyroidism	2.6	0.7-4.4
Idiopathic epilepsy[81]	2.1	1.6-2.6
Idiopathic cerebellar ataxia[87]	4.3	3.1-5.9
Dental enamel defects[93,94]	15	11-21

^aExpressed as a range.

NA: Not available.

Table 2 The sensitivity and specificity of the screening tests for celiac disease

Test	Sensitivity	Specificity
Anti-tissue transglutaminase antibody[97]	92.8% (95%CI: 90.3-94.8)	97.9% (95%CI: 96.4- 98.8)
Anti-endomysial antibody[97]	73% (95%CI: 61-83)	99.0% (95%CI 98.0-99.0)
Deamidated gliadin peptide antibodies[97]	87.8% (95%CI: 85.6-89.9)	94.1% (95%CI: 92.5-95.5)
Point-of care tests (107)
Anti-anti-tissue transglutaminase antibody + Anti-gliadin antibody	94.0% (95%CI: 89.9-96.5)	94.4% (95%CI: 90.9-96.5)
IgA anti-tissue transglutaminase antibody	90.5% (95%CI: 82.3-95.1)	94.8% (95%CI: 92.5-96.4)