A meta analysis of the literature published in the Archives of Internal Medicine (Arch Intern Med. 2009;169(7):651-658 Yield of Diagnostic Tests for Celiac Disease in Individuals With Symptoms Suggestive of Irritable Bowel Syndrome Alexander Ford; William Chey; Nicholas Talley; Ashish Malhotra; Brennan Spiegel; Paul Moayyedi) suggests that IBS patients have a significantly higher (four-fold) risk of being coeliac than non-IBS sufferers.
Below is the abstract of the work and a few extracts from the attached comments.
Individuals with irritable bowel syndrome (IBS) report abdominal pain, bloating, and diarrhea, symptoms similar to those in celiac disease. Studies suggest that the prevalence of celiac disease is increased in individuals with IBS; however, evidence is conflicting, and current guidelines do not always recommend screening for celiac disease in these individuals.
We conducted a systematic review and meta-analysis to estimate prevalence of celiac disease in unselected adults who met diagnostic criteria for IBS. MEDLINE (1950 to May 31, 2008) and EMBASE (1980 to May 31, 2008) were searched. Case series and case-control studies that used serologic tests for celiac disease were eligible for inclusion. Prevalence of positive serologic indications of celiac disease and biopsy-proved celiac disease were extracted and pooled for all studies and were compared between cases and controls using an odds ratio and 95% confidence interval.
Fourteen studies were identified comprising 4204 individuals, of whom 2278 (54%) met diagnostic criteria for IBS. Pooled prevalence of positive IgA-class antigliadin antibodies, either positive endomysial antibodies or tissue transglutaminase, and biopsy-proved celiac disease were 4.0% (95% confidence interval, 1.7-7.2), 1.63% (0.7-3.0), and 4.1% (1.9-7.0), respectively. Pooled odds ratios (95% confidence intervals) for positive IgA-class antigliadin antibodies, either positive endomysial antibodies or tissue transglutaminase, and biopsy-proved celiac disease in cases meeting diagnostic criteria for IBS compared with controls without IBS were 3.40 (1.62-7.13), 2.94 (1.36-6.35), and 4.34 (1.78-10.6).
Prevalence of biopsy-proved celiac disease in cases meeting diagnostic criteria for IBS was more than 4-fold that in controls without IBS.
'....Both IBS and celiac disease are prevalent conditions that share a common set of symptoms. The median time between seeing a physician because of symptoms and the ultimate diagnosis of celiac disease is 12 months. 14 previous studies indicate that individuals meeting diagnostic criteria for IBS might be at higher risk of harboring celiac disease compared with controls without IBS. However, data are conflicting (24-27). In light of this uncertainty, we performed a systematic review and meta-analysis to estimate (1) pooled prevalence of celiac disease in individuals meeting diagnostic criteria for IBS and (2) incremental odds of celiac disease in cases meeting diagnostic criteria for IBS vs matched controls without IBS....'
'...Because IBS is more prevalent than celiac disease, there remains the possibility that some of these individuals may truly have IBS with undiagnosed celiac disease and that the diagnosis of celiac disease is incidental. In this situation, the symptoms will not be truly attributable to celiac disease and may not improve with the patient's adherence to a gluten-free diet.
Only 2 of the included studies reported the effect of instituting a gluten-free diet on symptoms subsequently, and the number of included individuals was small; however, most of those who commenced a gluten-free diet reported that their symptoms were improved or resolved.
However, for several reasons, the studies included in this systematic review could also have underestimated the true prevalence of biopsy-proved celiac disease in individuals meeting diagnostic criteria for IBS. Serologic test results for celiac disease can be falsely negative in IgA deficiency, for which most of the studies did not screen. In addition, none of the studies assessed whether individuals were already excluding gluten from their diet in an attempt to alleviate symptoms before serologic testing or duodenal biopsy.
Only participants with positive celiac serology underwent distal duodenal biopsy. A recent article demonstrated that in individuals undergoing distal duodenal biopsy who had histologic findings in keeping with celiac disease, the sensitivity of tTGAs was substantially reduced in those without total villous atrophy.
In conclusion, this systematic review and meta-analysis demonstrate that the prevalence of biopsy-proved celiac disease in individuals meeting diagnostic criteria for IBS is in the region of 4%, and the odds for biopsy-proved celiac disease in these individuals is more than 4-fold that in healthy controls. If screening is to be undertaken, then EMA or tTGA testing should be preferred to IgA-class AGA testing because of a higher positive predictive value, although the yield will depend on the prevalence in the population being studied....'
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