Accuracy of potential diagnostic indicators for coeliac disease: a systematic review protocol

Martha M C Elwenspoek*, Joni Jackson, Sarah Dawson, Hazel Everitt, Peter Gillet, Alastair D Hay, Hayley E Jones, Deborah Lane, Susan Mallett, Gerry Robins, Athena Sheppard, Jo Stubbs, Howard H Z Thom, Jessica C Watson, Penny F Whiting

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

4 Citations (Scopus)
31 Downloads (Pure)


Introduction Coeliac disease (CD) is a systemic immune-mediated disorder triggered by gluten in genetically predisposed individuals. CD is diagnosed using a combination of serology tests and endoscopic biopsy of the small intestine. However, because of non-specific symptoms and heterogeneous clinical presentation, diagnosing CD is challenging. Early detection of CD through improved case-finding strategies can improve the response to a gluten-free diet, patients’ quality of life and potentially reduce the risk of complications. However, there is a lack of consensus in which groups may benefit from active case-finding.

Methods and analysis We will perform a systematic review to determine the accuracy of diagnostic indicators (such as symptoms and risk factors) for CD in adults and children, and thus can help identify patients who should be offered CD testing. MEDLINE, Embase, Cochrane Library and Web of Science will be searched from 1997 until 2020. Screening will be performed in duplicate. Data extraction will be performed by one and checked by a second reviewer. Disagreements will be resolved through discussion or referral to a third reviewer. We will produce a narrative summary of identified prediction models. Studies, where 2×2 data can be extracted or reconstructed, will be treated as diagnostic accuracy studies, that is, the diagnostic indicators are the index tests and CD serology and/or biopsy is the reference standard. For each diagnostic indicator, we will perform a bivariate random-effects meta-analysis of the sensitivity and specificity.

Ethics and dissemination Results will be reported in peer-reviewed journals, academic and public presentations and social media. We will convene an implementation panel to advise on the optimum strategy for enhanced dissemination. We will discuss findings with Coeliac UK to help with dissemination to patients. Ethical approval is not applicable, as this is a systematic review and no research participants will be involved.

PROSPERO registration number CRD42020170766.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:
Original languageEnglish
Article numbere038994
Number of pages6
JournalBMJ Open
Issue number10
Publication statusPublished - 5 Oct 2020

Structured keywords

  • HEB


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