Consider migraine, chronic liver disease for coeliac disease screening: study

Targeted testing, particularly of individuals with type 1 diabetes, osteoporosis, dermatitis herpetiformis, migraine, and chronic liver disease, could improve case-finding for Coeliac disease (CD) and in turn could promote timely treatment, reports a recent meta-analysis.

Moreover, while migraine and chronic liver disease have yet to be listed as risk factors in CD guidelines, their inclusion should be reassessed.

Drawing from the online databases of Medline, Embase, the Cochrane Library, and Web of Science, the researchers included 191 eligible studies reporting on a total of 26 diagnostic indicators: seven symptoms, 17 risk conditions, and two genetic markers.

Dermatitis herpetiformis emerged as the risk condition with the highest positive predictive value (PPV) of 29 percent at 1-percent CD prevalence. However, the uncertainty for such estimate was high, with 95 percent confidence intervals of 3–72 percent.

Other notable potential predictors of CD included: migraine, a positive family history, an HLA DQ2/8 genotype, type 1 diabetes, chronic liver disease, and osteoporosis, all of which had PPVs above 2 percent. Meanwhile, arthritis, fractures, type 2 diabetes, psoriasis, multiple sclerosis, and systemic lupus erythematosus, among other conditions, had insufficient or weak evidence supporting their diagnostic ability for CD.

“Most of the promising indicators from our review, such as type 1 diabetes, thyroid disease, and osteoporosis, are recommended to prompt testing for CD by current guidelines,” the researchers said. “However, migraine, which had one of the higher estimated PPVs for CD, and chronic liver diseases are not mentioned in most current guidelines.

“Future guidelines may want to recommend general practitioners to consider CD testing in patients with migraine or chronic liver disease,” they added.