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There is a new article on Medscape about Irritable Bowel Syndrome (IBS) that is pertinent to Celiac Disease diagnosis.  First of all, that IBS symptoms are very common and are the cause for many doctor visits. It also states that in most cases without "alarm symptoms" testing for organic disease is currently considered unnecessary.  However, it points out that the one exception to this may be testing for Celiac Disease, but that this hasn't been proven yet!!  

So many medical studies are published, yet few seem to be accepted as conclusive.  If it could be demonstrated in a properly-designed study that patients presenting with IBS symptoms should be screened for Celiac Disease, this would make a significant difference in diagnosis rates.  Personally, I'm alarmed that according to current guidelines, someone going to the doctor for diarrhea attacks or constipation should not be tested for Celiac Disease.  

If anyone out there is in a position to suggest, conduct, or support research, this would be a very good possibility!  I've included some excerpts from the Medscape article below.  The link to the full article is at the bottom.  


IBS is a common condition, with prevalence estimates ranging between 7 and 24% in women and between 5 and 19% in men in the United States and Britain.[1-3] The symptoms of IBS represent one of the most common reasons for primary care visits, and consultation with a gastroenterologist accounting for 2.4-3.5 million physician visits per year.[1,4] Patients with IBS visit their physicians more frequently than those without IBS for both GI-related and non-GI-related problems, reflecting the increased likelihood of a variety of other conditions such as migraine headache, fibromyalgia and chronic pelvic pain.[5,6]

Current evidence does not support the performance of exhaustive testing to exclude organic diseases in patients fulfilling symptom-based IBS criteria without alarm features. Preliminary evidence suggests that celiac disease may be more prevalent in patients with suspected IBS, though these findings need to be validated in additional appropriately designed trials before routine screening for celiac disease in IBS patients can be recommended. 
The American College of Gastroenterology (ACG) Functional Gastrointestinal Disorders Task Force recently published clinical practice guidelines on the approach to the management of IBS in North America.[21]  Based upon the results of a recent systematic review, the task force opined that the routine performance of diagnostic tests in patients with suspected IBS without alarm features is not supported by the available literature. That is not to say that diagnostic testing never uncovers abnormal results in patients who fulfil symptom-based criteria for IBS. In fact, abnormalities are infrequently identified, but the likelihood of finding such abnormalities is not different in patients with suspected IBS when compared with non-IBS controls. The one possible exception to this statement relates to celiac disease, which in preliminary studies appears to be more prevalent in patients with suspected IBS than in non-IBS controls. The task force concluded that the current level of evidence merited a Grade C recommendation. Grade C recommendations derive from nonrandomized trials with contemporaneous controls and nonrandomized trials with historical controls.

There are additional considerations that should be used when evaluating trials involving the performance of diagnostic tests. For details, the reader is referred to the recently published STARD initiative, which provides recommendations regarding an appropriately designed and analysed study evaluating diagnostic accuracy.[11-13] The STARD initiative is designed to help editors, reviewers and readers establish the 'evidence-base' for studies about diagnosis. By adhering to specific methodologic criteria, methodologically sound studies of diagnosis should produce results that are more accurate, precise and useful to clinicians. For example, studies about the diagnostic accuracy of a test should include a blinded comparison with an established gold standard test, if available. They should also include an appropriate spectrum of patients. With respect to the diagnosis of IBS, clinical trials of diagnostic tests should include patients in whom the pretest probability of IBS or organic disease is similar. The pretest probability of any medical condition is influenced by multiple factors, such as the prevalence of the disease in question within a specific population, patient demographics and historical features, and ultimately depends upon clinical judgment. 

http://www.medscape.com/viewarticle/481182

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