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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