Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Given that Celiac disease currently affects at least 3 million Americans and has a prevalence of 1 out of 133 healthy individuals, what is the diagnostic accuracy of different screening tests for Celiac disease?

Additionally, given the high prevalence of Celiac disease and the varied presentation of symptoms, what are the comparative benefits and harms of different screening tests and what are the implications of universal screening for Celiac disease?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Comparisons of the diagnostic accuracy of different antibody tests and comparison of antibody testing to blood indices, and comparison to biopsy as the gold standard.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

All populations.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Subgroup analyses by race would be interesting.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Efficacy of early diagnosis in mitigating downstream health complications (e.g. GI cancers)

Describe any health-related risks, side effects, or harms that you are concerned about.

Inaccurate diagnoses leading to undetected Celiac disease and the subsequent health complications.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cancer
• Depression and other mental health disorders
• Developmental delays, attention-deficit hyperactivity disorder, and autism
• Functional limitations and disability
• Peptic ulcer disease and dyspepsia

AHRQ Priority Populations

• Low income groups
• Women
• Children
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare
• State Children's Health Insurance Program (SCHIP)
• Other

Importance

Describe why this topic is important.

3 million Americans are impacted and the prevalence globally is increasingly acknowledged. Untreated Celiac disease leads to other health complication and higher health care costs.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

The increasing awareness and diagnosis of Celiac disease seems to warrant in depth scientific study.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

It would be helpful to understand the reliability of test to diagnose the disease.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Describe the timeframe in which an answer to your question is needed.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program