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Summary #2 - Irritable Bowel Syndrome
Joe Murray of the Mayo Clinic spoke at the 1999 national conference here in
Calgary. He said that about 50% of celiacs also meet the ROME criteria for
IBS. If correct, that means that many cases of IBS are really cases of
undiagnosed celiac disease.
Several studies have looked for celiac disease among patients with a
diagnosis of IBS. Different studies reveal a range of rates of celiac
disease among IBS patients, but even the most conservative ones show that a
significant percentage of them have hitherto unrecognized celiac disease.
Here are a couple of relevant abstracts:
1: Gastroenterology 2001 Dec;121(6):1329-38 Related Articles, Books, LinkOut
Comment in:
Gastroenterology. 2001 Dec;121(6):1512-5.
Celiac disease-like abnormalities in a subgroup of patients with irritable
bowel syndrome.
Wahnschaffe U, Ullrich R, Riecken EO, Schulzke JD.
Department of Gastroenterology and Infectious Diseases, Universitatsklinikum
Benjamin Franklin, Freie Universitat Berlin, D-12200 Berlin, Germany.
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BACKGROUND & AIMS: Abdominal symptoms in the absence of mucosal
abnormalities are features of both the irritable bowel syndrome (IBS)
and latent/potential celiac disease (cd). To identify a possible
subgroup of IBS patients with latent/potential cd, surrogate markers of
cd were investigated in IBS patients. METHODS: IBS patients suffering
from diarrhea (n = 102), and patients with active cd (n = 10), treated
cd (n = 26), and latent cd (n = 5) were included in the study. We
measured serum immunoglobulin (Ig) A against gliadin and tissue-
transglutaminase, and IgA and IgM against gliadin, tissue-
transglutaminase (intestinal cd-associated antibodies), and the dietary
proteins beta-lactoglobulin and ovalbumin in duodenal aspirate by enzyme-
linked immunosorbent assay. Intraepithelial lymphocytes (IELs) were
counted in histology sections, and the expression of HLA-DQ2
(A1*0501/B1*0201) was investigated by polymerase chain reaction. In 26
IBS patients, the effect of 6 months of gluten withdrawal was examined.
RESULTS: Most cd patients expressed HLA-DQ2 and had increased
intestinal cd-associated antibodies, whereas cd-associated serum IgA and
IEL counts were increased in active cd in contrast to treated or latent
cd. In IBS patients, 35% were HLA-DQ2-positive, 23% had increased IEL
counts, and 0% and 30% had increased cd-associated antibodies in serum
and duodenal aspirate, respectively. Furthermore, stool frequency and
intestinal IgA decreased significantly under a gluten-free diet in the
subgroups of HLA-DQ2-positive and intestinal antibody-positive IBS
patients when compared with IBS patients without these markers.
CONCLUSIONS: HLA-DQ2 expression and increased intestinal cd-associated
antibodies are markers that can identify latent/potential cd in a
subgroup of IBS patients who consequently appear to profit from a gluten-
free diet.
PMID: 11729112 [PubMed - indexed for MEDLINE]
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2: Lancet 2001 Nov 3;358(9292):1504-8 Related Articles, Books, LinkOut
Comment in:
Lancet. 2001 Nov 3;358(9292):1475.
Lancet. 2002 Apr 13;359(9314):1346.
Lancet. 2002 Apr 13;359(9314):1346.
Lancet. 2002 Apr 13;359(9314):1347.
Association of adult coeliac disease with irritable bowel syndrome: a
case-control study in patients fulfilling ROME II criteria referred to
secondary care.
Sanders DS, Carter MJ, Hurlstone DP, Pearce A, Ward AM, McAlindon ME, Lobo
AJ.
Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK.
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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=0.004, odds ratio=7.0 [95% CI 1.7-28.0]). 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.
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