Meta-analysis: Yield of diagnostic tests for coeliac disease in dyspepsia

Abstract

Background The prevalence of coeliac disease (CD) may be increased in individuals with dyspepsia, but evidence is conflicting. Aims To conduct a systematic review and meta-analysis of studies reporting prevalence of CD in dyspepsia. Methods MEDLINE, EMBASE, and CINAHL were searched up to February 2009. Case series and case-control studies applying serological tests andor distal duodenal biopsy for CD to unselected adults with dyspepsia were eligible. Prevalence of positive coeliac serology and biopsy-proven CD were pooled for all studies and compared between cases and controls using an odds ratio (OR) and 95% confidence interval (CI). Results Fifteen studies were identified. Prevalence of positive coeliac serology was higher in cases with dyspepsia (7.9%) compared with controls (3.9%), but not significantly so (OR for positive endomysial antibodies or tissue transglutaminase 1.89; 95% CI 0.90-3.99). Prevalence of biopsy-proven CD following positive serology was also higher (3.2% in cases vs. 1.3% in controls), but again this was not statistically significant (OR 2.85; 95% CI 0.60-13.38). Prevalence of biopsy-proven CD was 1% in ten studies performing duodenal biopsy first-line. Conclusion Prevalence of biopsy-proven CD in subjects with dyspepsia was 1% and was higher than in controls, although this difference was not statistically significant. © 2009 Blackwell Publishing Ltd.