Celiac disease more common in patients with IBS symptoms, study confirms

Last Updated: 2016-10-31

By Anne Harding

NEW YORK (Reuters Health) - People with symptoms of irritable bowel syndrome (IBS) are much more likely to have celiac disease (CD) than those who don't have IBS symptoms, new research confirms.

"People with symptoms that sound like IBS should be screened for celiac disease, regardless of IBS subtype," Dr. Alexander Ford of Leeds Gastroenterology Institute at St. James University Hospital in Leeds, U.K., an author of the new study, told Reuters Health by email. The findings were published online October 18 in the American Journal of Gastroenterology.

CD and IBS share symptoms including abdominal pain, bloating and bowel habit changes, which can lead to CD being mislabeled as IBS, Dr. Ford and his team note.

In 2009, the researchers published a meta-analysis showing that CD was four times as common in people with IBS-type symptoms compared to those without symptoms, and other studies have suggested that ruling out CD in IBS patients could be cost-effective.

Based in part on this research, current guidelines recommend opportunistic screening of patients with IBS-like symptoms for CD using serological testing. But new research has suggested that this approach may not be worthwhile, the researchers add.

To update their 2009 meta-analysis, the researchers looked at 36 studies including more than 15,000 people, 61% of whom met IBS criteria. Twenty-two of the studies were new.

All of the studies had recruited patients based on IBS symptoms, and tested them for CD using IgA-class antigliadin antibodies (AGA), endomysial antibodies (EMA), tissue transglutaminase antibodies (tTG) or duodenal biopsies performed after positive serology.

The odds ratio for a positive CD test among people with IBS were 3.21 based on IgA AGAs; 2.75 for EMA and/or tTG; and 4.48 for duodenal biopsy. The findings were consistent for patients with constipation, diarrhea, and mixed-stool pattern IBS.

The pooled prevalence of biopsy-proven CD among the patients with IBS-type symptoms was 3.3%.

There was no association between IBS and CD in the small number of North American studies, and population-based studies had inconsistent results.

"The largest North American study was conducted in the community (a population-based study), and the prevalence of coeliac disease is lower in the community than in patients referred to hospital, so this may have affected the findings," Dr. Ford noted.

The findings support screening of IBS patients for CD in secondary- and tertiary-care settings outside North America, the researchers write, while the usefulness of community or primary-care based screening remains unclear.

"Further studies to improve our understanding of the yield and cost-effectiveness of screening for CD in these settings are encouraged," they conclude.

SOURCE: http://bit.ly/2f4kxRb

Am J Gastroenterol 2016.