Review and Critical Appraisal of Clinical Practice Guidelines of Modalities Used in the Diagnosis of Celiac Disease

Background There is controversy over the recommendations for specific serological strategies implemented and the need for a biopsy to confirm celiac disease (CeD). We reviewed and appraised the current clinical practice guidelines (CPGs) to assess the quality and reliability of recommendations for CeD diagnosis in pediatric and adult populations.Methods We searched databases, including MEDLINE, EMBASE, Web of Science, and CINAHL, between December 2010 and January 2021 for CPGs. Four independent reviewers extracted data. Appraisal of Guidelines Research and Evaluation (AGREE II) criteria were applied by two reviewers, and a standardized score was calculated for each of the six domains. A cut-off of 60% was used to identify high-quality guidelines.Results A total of 654 records were identified, 10 of which were eligible for data extraction. Both adult and pediatric CPGs averaged above 70% for the domains of 'scope and purpose' and 'clarity and presentation'. For 'stakeholder involvement', the mean adult and pediatric CPG scores were below the cut-off. Only one adult-focused guideline exceeded the cut-off for the 'rigour of development' domain. 'Applicability' scores were most alarming, with adult CPGs averaging 21% and pediatric CPGs averaging 23%.Conclusion Our review and appraisal of the CPGs for the diagnosis of CeD highlight significant discrepancies in clinical recommendations and some concerns regarding methodological rigour, particularly in stakeholder engagement, rigour, and applicability. Creating a Canadian guideline of high methodological quality that overcomes these weaknesses is critical to optimize patient care and ensuring accurate diagnoses in CeD. Accurate tests are important for the diagnosis of celiac disease (CeD), a reaction of the immune system after eating gluten, the protein found in wheat, rye and barley. There is controversy over the recommendations on which test is more effective for the diagnosis of CeD. We reviewed the current guidelines (CPGs) with recommendations on the most appropriate test for diagnosis of CeD and rated the guidelines using a valid tool to assess the scientific content of recommendations for CeD diagnosis in pediatric and adult populations. We searched several databases to find these guidelines published in medical journals between December 2010 and January 2021. Two reviewers rated the scientific quality of the guidelines using the Guidelines Research and Evaluation (AGREE II). Based on previous studies using this tool, we considered that a score over 60% was a high-quality guideline. We found inconsistencies in recommendations on how to diagnose CeD, and some concerns regarding methodological rigour between guidelines. Inconsistent recommendations can confuse providers and funders, leading to a delay in diagnosis and unnecessary diagnostic procedures. We hope future guideline developers will use the strengths and weaknesses identified in this review to help physicians, government institutions and patients. Graphical Abstract