Should All Patients with IBS be Screened for Celiac Disease?
Screening patients with irritable bowel syndrome (IBS) or other functional gastrointestinal disorders for celiac disease isn’t much more effective than screening the general population, researchers report in the November issue of Clinical Gastroenterology and Hepatology.
Celiac disease produces symptoms similar to those of IBS, such as lower abdominal pain, diarrhea, and abdominal bloating or distention. Guidelines therefore recommend that all patients with IBS be tested for celiac disease. However, there is controversy over whether celiac disease is more prevalent in populations with IBS-like symptoms.
Rok Seon Choung et al investigated whether subjects with positive results from serologic tests for celiac disease are frequently diagnosed with IBS or other functional gastrointestinal disorders (FGIDs).
They sent self-report bowel disease questionnaires to 7217 residents of Olmsted County, Minnesota, to collect data on symptoms compatible with functional GI disorders, including IBS, collecting data on symptoms compatible with functional GI disorders, including IBS. These symptom data were linked to surveys of undiagnosed celiac disease conducted among more than 47,000 individuals from the same region, based on results of tests for immunoglobulin A tissue transglutaminase and then endomysial antibody.
Among the 3202 subjects who completed the questionnaires and had their serum sample analyzed, 13.6% had IBS and 55.2% had some gastrointestinal symptoms.
The prevalence of celiac disease, based on serologic markers, was 1.0%. However, whereas 3% of patients with celiac disease met the criteria for IBS, 14% of patients without celiac disease met the criteria for IBS.
Abdominal pain, constipation, weight loss, and dyspepsia were the most frequent symptoms reported by subjects who tested positive for celiac disease, but none of the gastrointestinal symptoms or disorders were significantly associated with results of serologic test for celiac disease.
The authors conclude that gastrointestinal symptoms are relatively common in subjects with undiagnosed celiac disease, but comparable to those of adults without celiac disease. These results have important management and screening implications—testing patients with IBS probably does not identify any more people with celiac disease than testing the general population.
In an editorial that accompanies the article, Alexander C Ford explains that it is important to distinguish between IBS and celiac disease because the treatments are quite different. Patients with celiac disease are advised to adhere to a lifelong gluten-free diet, whereas patients with IBS usually are treated for their symptoms, often with pharmacologic or psychologic approaches.
Ford points out that the study was performed in a specific population of the US, and that the mean age of people who took the survey in this study was 61 years old. Celiac disease has a bimodal age distribution and, in the United States, IBS is more common in younger individuals.
However, a previous study found similarly low prevalence of biopsy-proven celiac disease (0.4%) in 492 patients with IBS. Ford says that physicians should question the value of screening patients with suspected IBS in the US, but recommendations should not change for practice in primary or secondary care in other countries.