The Prevalence of Celiac Disease Among Patients With Nonconstipated Irritable Bowel Syndrome Is Similar to Controls

Abstract

Background & Aims Guidelines recommend that patients with symptoms of non-constipated inflammatory bowel syndrome (NC-IBS) undergo testing for celiac disease (CD). We evaluated the prevalence of CD antibodies and biopsy confirmed CD among patients with NC-IBS in a large US population. Methods In a study conducted at 4 sites, from 2003 to 2008, we compared data from 492 patients with symptoms of NC-IBS to 458 asymptomatic individuals who underwent colonoscopy examinations for cancer screening or polyp surveillance (controls). All participants provided blood samples for specific and non-specific CD-associated antibodies. Additionally, patients with IBS were analyzed for complete blood cell counts, metabolic factors, erythrocyte sedimentation rates, and levels of C-reactive protein and thyroid-stimulating hormone. Any subjects found to have CD-associated antibodies were offered esophagogastroduodenoscopy and duodenal biopsy analysis. Results Of patients with NC-IBS, 7.3% had abnormal results in tests for CD-associated antibodies, compared to 4.8% of controls (adjusted odds ratio=1.49; 95% confidence interval, 0.76–2.90. P=.25). Within the NC-IBS group, 6.51% had antibodies against gliadin, 1.22% against tissue transglutaminase, and 0.61% against endomysium (P>.05 vs controls for all antibodies tested). CD was confirmed in 0.41% of patients in the NC-IBS group and 0.44% of controls (P>0.99). Conclusions Although CD-associated antibodies are relatively common, the prevalence of CD among patients with NC-IBS is similar to that among controls in a large US population. These findings challenge recommendations to routinely screen patients with NC-IBS for CD. More than 7% of patients with NC-IBS had CD-associated antibodies, indicating that gluten sensitivity might mediate IBS symptoms; further studies are needed.

The Utility of Routine Endoscopic Distal Duodenal Biopsy in Patients with Irritable Bowel Syndrome for Celiac Disease Diagnosis; First Study from Nepal

“…Although the most recent studies in the United States question the justification of searching for CD [24,25] in patients with IBS, our study supported this. A limitation of our study is that we did not have a control group.…”

“…The majority of the previous studies have included patients that were diagnosed with IBS based on clinical criteria or the Rome II criteria [16,24,25]. Some studies did not evaluate patients according to IBS subtypes.…”

“…In a four-center study in the United States conducted on patients with non-constipated IBS, Cash et al [24] found that the prevalence of CD was similar to that of a control population (0.41% vs. 0.44%, p = 0.99). In another study by Choung et al [25] revealed that seropositive CD prevalence in subjects with symptoms suggestive of functional gastrointestinal disorders was only 1%.…”

Validation of the Rome III Criteria for the Diagnosis of Irritable Bowel Syndrome in Secondary Care

“…However, where celiac serology was positive, distal duodenal biopsy was performed, and those individuals with celiac disease were classified as having organic disease within our analyses. The relevance of these issues is debatable, as a recent study suggests that, within a North American population, there is no difference in the prevalence of celiac disease in non-constipated IBS patients compared with controls, 35 and previous studies that have applied a routine panel of blood tests or small bowel investigations in patients with suspected IBS demonstrate a yield for organic disease of ≤1%. 13,36,37 In a previous meta-analysis of four validation studies of the Manning criteria for IBS, 19, 27-29 containing a total of 574 patients, the positive and negative LRs of the Manning criteria were 2.9 and 0.29 respectively.…”

Novel Therapies in IBS-D Treatment

“…In the absence of alarm features, a positive diagnosis of IBS can usually be made with limited diagnostic testing. Celiac antibody testing, such as tissue transglutaminase antibody (anti-tTG), is recommended by the ACG Task Force [9] for patients with IBS-D though a recent study from the USA failed to find a higher rate of celiac disease in a large cohort of IBS-D patients [10]. In a 2002 systematic review of 20,000 patients presenting with symptoms of IBS, the presence of abdominal pain decreased the likelihood of a diagnosis of colon cancer and the absence of abdominal pain increased the likelihood [11,12].…”