Elwenspoek Martha Maria Christine, Jackson Joni, Dawson Sarah, Everitt Hazel, Gillett Peter, Hay Alastair D, Jones Hayley E, Lane Deborah L, Mallett Susan, Robins Gerry, Sheppard Athena Louise, Stubbs Jo, Thom Howard, Watson Jessica, Whiting Penny
The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
BMJ Open. 2020 Oct 5;10(10):e038994. doi: 10.1136/bmjopen-2020-038994.
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.
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.
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.
CRD42020170766.
乳糜泻（CD）是一种由麸质引发的系统性免疫介导疾病，好发于具有遗传易感性的个体。CD的诊断采用血清学检测和小肠内镜活检相结合的方法。然而，由于症状不具有特异性且临床表现多样，CD的诊断具有挑战性。通过改进病例发现策略早期检测CD，可改善对无麸质饮食的反应、提高患者生活质量并可能降低并发症风险。然而，对于哪些群体可能从主动病例发现中获益，目前尚无共识。
我们将进行一项系统评价，以确定成人和儿童CD诊断指标（如症状和危险因素）的准确性，从而有助于识别应接受CD检测的患者。将检索1997年至2020年期间的MEDLINE、Embase、Cochrane图书馆和科学网。筛选将重复进行。数据提取将由一人进行，第二审阅者进行核对。分歧将通过讨论或转介给第三审阅者解决。我们将对已识别的预测模型进行叙述性总结。对于可以提取或重建2×2数据的研究，将作为诊断准确性研究进行处理，即诊断指标为索引测试，CD血清学和/或活检为参考标准。对于每个诊断指标，我们将对敏感性和特异性进行双变量随机效应荟萃分析。
结果将在同行评审期刊、学术和公众报告以及社交媒体上发表。我们将召集一个实施小组，就加强传播的最佳策略提供建议。我们将与英国乳糜泻协会讨论研究结果，以帮助向患者传播。由于这是一项系统评价，不涉及研究参与者，因此无需伦理批准。
PROSPERO注册号：CRD42020170766。
