<<Disclaimer: Verify this information before applying it to your situation.>> The following article appeared in this week's edition of The Lancet (leading UK medical journal) about a British study of patients with persistent Irritable Bowel Syndrome referred to gastroentrology departments for investigation for coeliac disease (among other tests) compared to a healthy control group. This address will give the abstract (given below) if you register (free). The full article, which also makes interesting reading, has to be paid for: http://www.thelancet.com/search/search.isa Amonst its findings are that about 74% had their IBS diagnosis confirmed but almost 20% had"organic abnormalities" (like diverticulitis), the largest group of which were diagnosed with CD(5%). So it's clear that long-term IBS sufferers should get investigated thoroughly, especially for CD, before accepting an IBS diagnosis. Also interesting is the fact only one of the 300 (0.3%) tested positive for lactose intolerance, supporting what many celiacs believe about the nonsense of those friends with IBS who won't get tested for CD because they think their problem is lactose. From this study the ratio of coeliac to lactose intolerant is 15/1 amonst persistent IBS sufferers. (There is incidentally no indication of the ethnicity of the two British groups used but I assume it was predominently white). The researchers' other interpretation that "with only EMA, 3 of 14 cases would have been missed."refers to the false negatives EMA alone gives and therefore the importance of having all relevant antibody tests (in the UK sometimes only the EMA test is done because of costs). The other interesting finding is that 2 of the 300 healthy controls without symptoms had CD, supporting other recent studies in Europe on healthy populations showing an incidence of 1 in 100-200. When this figure is combined CD's incidence among people with symptoms and confirmed CD cases a rate of at least 1% seems reasonable. *Incidentally a list of the "Rome 2" criteria for IBS can be found here: http://ibscrohns.about.com/library/weekly/aa101101a.htm Abstract from The Lancet: Lancet Nov 2001 Volume 358, Number 9292 1504-08 03 Association of adult coeliac disease with irritable bowel syndrome: a case-control study in patients fulfilling ROME II criteria referred to secondary care by David S Sanders et al. Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK (D S Sanders MRCP, M J Carter MRCP, D P Hurlstone MRCP, M E McAlindon MD, A J Lobo MD); University of Sheffield Medical School, Sheffield (A Pearce MBBS); and Supra-Regional Protein Reference Unit, Northern General Hospital, Sheffield (A Milford Ward FRCPath) Summary : Background Irritable bowel syndrome has a high prevalence. Consensus diagnostic criteria (ROME II) based on symptoms have been established to aid diagnosis. Although coeliac disease can be misdiagnosed as irritable bowel syndrome, no prospective study has been published in which patients with this disorder are investigated for coeliac disease. We aimed to assess the association of coeliac disease with irritable bowel syndrome in patients fulfilling ROME II criteria.* Methods: We undertook a case-control study at a university hospital. 300 consecutive new patients who fulfilled Rome II criteria for irritable bowel syndrome, and 300 healthy controls (age and sex matched) were investigated for coeliac disease by analysis of serum IgA antigliadin, IgG antigliadin, and endomysial antibodies (EMA). Patients and controls with positive antibody results were offered duodenal biopsy to confirm the possibility of coeliac disease. Findings: 66 patients with irritable bowel syndrome had positive antibody results, of whom 14 had coeliac disease (11 EMA positive, three EMA negative). Nine patients with positive antibody results were lost to follow-up or refused biopsy (only one EMA-positive patient refused biopsy), and 43 had normal duodenal mucosa. Two controls, both of whom were EMA positive, had coeliac disease. Compared with matched controls, irritable bowel syndrome was significantly associated with coeliac disease (p=0o004, odds ratio=7o0 [95% CI 1o7-28o0]). Interpretation: Patients with irritable bowel syndrome referred to secondary care should be investigated routinely for coeliac disease. With only EMA, three of 14 cases would have been missed. Lancet Editorial and review commentary by Roland Valori (another gastroenterologist): "Not all of the many people with chronic abdominal symptoms seek medical care, and only a tiny proportion filter through to secondary care." Charlotte Ward-Perkins, Oxford, UK