Remarkable prevalence of coeliac disease in patients with irritable bowel syndrome plus fibromyalgia in comparison with those with isolated irritable bowel syndrome: a case-finding study

Abstract

IntroductionIrritable bowel syndrome (IBS) and fibromyalgia syndrome (FMS) are two common central sensitization disorders frequently associated in the same patient, and some of these patients with IBS plus FMS (IBS/FMS) could actually be undiagnosed of coeliac disease (CD). The present study was an active case finding for CD in two IBS cohorts, one constituted by IBS/FMS subjects and the other by people with isolated IBS.MethodsA total of 104 patients (89.4% females) fulfilling the 1990 ACR criteria for FMS and the Rome III criteria for IBS classification and 125 unrelated age- and sex-matched IBS patients without FMS underwent the following studies: haematological, coagulation and biochemistry tests, serological and genetic markers for CD (i.e., tissue transglutaminase 2 (tTG-2) and major histocompatibility complex HLA-DQ2/HLA-DQ8), multiple gastric and duodenal biopsies, FMS tender points (TPs), Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ), 36-Item Short Form Health Survey (SF-36) and Visual Analogue Scales (VASs) for tiredness and gastrointestinal complaints.ResultsAs a whole, IBS/FMS patients scored much worse in quality of life and VAS scores than those with isolated IBS (P < 0.001). Seven subjects (6.7%) from the IBS/FMS group displayed HLA-DQ2/HLA-DQ8 positivity, high tTG-2 serum levels and duodenal villous atrophy, concordant with CD. Interestingly enough, these seven patients were started on a gluten-free diet (GFD), showing a remarkable improvement in their digestive and systemic symptoms on follow-up.ConclusionsThe findings of this screening indicate that a non-negligible percentage of IBS/FMS patients are CD patients, whose symptoms can improve and in whom long-term CD-related complications might possibly be prevented with a strict lifelong GFD.

Determining the association between fibromyalgia, the gut microbiome and its biomarkers: A systematic review

“…As a result of this investigation, seven of the 104 patients with fibromyalgia were subsequently diagnosed with coeliac disease (20).…”

Fibromyalgia: Treating Pain in the Juvenile Patient

“…Celiac disease and non-gluten celiac gluten sensitivity (NCGS) both have been found to have a high prevalence in patients with FMS [70, 71]. In a study of 50 children with JFMS, only 1 had celiac disease and her pain level increased when on a gluten free diet [72].…”

Celiac disease and fibromyalgia: Is there an association?

“…However, it may be difficult to know which patient would benefit from such approach. Not only the symptoms of CD and NCGS may be atypical and quite mild (2) as most FM patients have gastrointestinal symptoms due to the high degree of association of FM with irritable bowel syndrome (IBS) (1,2). Indeed, there is a suspicion of underlying gluten sensitivity among patients with IBS and it has been shown that IBS patients have much higher prevalence of CD than the general population (2,4).…”

“…In patients with FM plus CD or NCGS, the treatment with gluten-free diet has shown to improve symptoms, including musculoskeletal pain and fatigue (1). FM is a very difficult disease to treat.…”

“…It has been found that celiac disease (CD) and non-celiac gluten sensitivity (NCGS) have a high prevalence in fibromyalgia (FM) patients (1)(2)(3). NCGS is a relatively new entity characterized by gastrointestinal and extra-intestinal manifestations in the absence of CD or wheat allergy (3).…”