The prevalence of celiac disease in patients fulfilling Rome III criteria for irritable bowel syndrome

BACKGROUND AND AIMS

Celiac disease shares several symptoms which constitute some of the ROME criteria used for the diagnosis of irritable bowel syndrome (IBS), and as such many patients with underlying Celiac disease may be mistakenly diagnosed as having IBS. The aim of the present study was to determine the prevalence of Celiac disease in patients with IBS fulfilling ROME III criteria.

MATERIALS AND METHODS

Patients who fulfilled ROME III criteria for irritable bowel syndrome were screened for Celiac disease using the Biocard(TM) Celiac Disease Stick test, and patients who tested positive had their serum samples analyzed for antigliadin IgA and IgG, and anti-tissue transglutaminase IgA antibodies. Patients with detectable antibody levels underwent endoscopic duodenal biopsy to confirm a diagnosis of Celiac disease.

RESULTS

Two of 100 patients who were diagnosed as having irritable bowel syndrome as per the Roma III criteria were found to have elevated levels of serum antigliadin IgA and IgG, and anti-tissue transglutaminase IgA antibodies, with histological evidence of Celiac disease on examination of duodenal biopsy. Both patients were started on a gluten-free diet, showing significant improvement in their symptoms on follow-up.

CONCLUSIONS

Celiac disease is a common finding among patients labeled as IBS. Celiac disease must be considered in differential diagnosis of IBS especially in the therapy refractory group.

An Evidence-based Approach to Therapy in IBS-D: A Case Study Compendium

A burden on both patients and the healthcare system, irritable bowel syndrome (IBS) is a prevalent condition that can result in high medical costs, frequent visits to the doctor, missed work, and anxiety and depression in the patient. This chronic disorder causes abdominal pain or discomfort and is characterized by abnormal defecation that presents mainly as either constipation or diarrhea symptoms. IBS associated with diarrhea (IBS-D) accounts for approximately one third of all IBS patients. IBS-D treatment can be confusing and frustrating for both the patient and the physician, complicated by the fact that a specific therapeutic algorithm has not been developed. Treatment options are widely varied, consisting of both nonpharmacologic (dietary changes) and pharmacologic (loperamide and alosetron) interventions. Furthermore, mounting evidence suggests a possible role for small intestinal bacterial overgrowth in the pathogenesis of IBS-D; thus, both antibiotics (such as rifaximin) and probiotics are frequently used to treat patients. Although all of these interventions elicit some measure of symptom response in a proportion of treated patients, there is no standard of care for the treatment of IBS-D. Thus, physicians would benefit from knowledge of all of the strategies used to treat IBS-D, in order to treat patients appropriately.