# No Link Found Between Celiac Disease and Irritable Bowel Syndrome



## eric (Jul 8, 1999)

No Link Found Between Celiac Disease and Irritable Bowel Syndrome See your ad here!Site Sponsor:Gluten Free Food& Drug SmartLists: Mayo Clin Proc 2004;79:476-482.Celiac.com 05/25/2004 - The results of a study conducted by Dr. G. Richard Locke III and colleagues at the Mayo Clinic College of Medicine in Rochester, Minnesota do not show an association between irritable bowel syndrome (IBS) and celiac disease. The case-control study was based on the respondents of a bowel disease questionnaire that was sent to random Olmsted County residents who were 20 to 50 years old. The researchers evaluated 150 subjects, 72 of whom reported having symptoms of IBS and dyspepsia, and 78 controls with no gastrointestinal symptoms. In the group with symptoms they found that 50 had IBS, 24 had dyspepsia and 15 had both conditions. Serological screening of both groups for celiac disease showed no significant difference between them?two controls, two IBS subjects and two people with dyspepsia tested positive for celiac disease. The researchers conclude that celiac disease alone cannot explain the presence or IBS or dyspepsia in the subjects. The results of this study are interesting, but probably not large enough to be statistically significant. The total number of people with celiac disease in each group was astounding:2 out of 50 with IBS (4%)2 out of 24 with dyspepsia (6%) 2 of the 78 controls (2.6%)These findings do not necessarily contradict previous IBS/CD studies that looked at hospital outpatients who are more likely to have more severe and prolonged symptoms than a group that selects itself from the general public by responding to a questionnaire. Additionally most of the earlier studies that concluded that there was a connection between celiac disease and IBS were conducted before more recent epidemiological studies that have shown just how high the incidence of celiac disease in the general population is--now estimated between 0.8% and 1.3%--this study suggests 2 -3%. These recent epidemiological studies have also shown that a large percentage of celiacs have little or no symptoms, perhaps due to the length of time or the severity of the disease. A 1 in 20 diagnosis of celiac disease in patients with IBS/dyspepsia is consistent with other studies, and is still high and suggests that testing for celiac disease should be done routinely on these patients. No studies have ever suggested that all or even most IBS patients have celiac disease, just that the incidence is higher than that of the normal population. I propose that if this study had been done on exactly the same people several years from now, the 2 people in the control group who were found to have celiac disease may well develop symptoms that would put them in either the IBS or dyspepsia group, which would create a statistically significant result that would contradict this study's result. Last, perhaps the results of this study really support a more broad conclusion: Everyone ought to be screened for celiac disease, not just those with symptoms. http://www.celiac.com/st_prod.html?p_prodid=972and "Irritable Bowel Syndrome: Does it Cause other Disease? By: W. Grant Thompson MD, Emeritus Professor of Medicine, University of Ottawa, Ontario, Canada There are many discussions of the plausible causes of the irritable bowel syndrome (IBS), but the question of whether IBS causes other diseases receives less attention. It is a further paradox that we know little about the cause of IBS, yet can be confident that it causes no serious intestinal disease. The syndrome can be very troublesome and disruptive, but it is incorrect to blame it for structural gut diseases. A discussion of IBS and colon cancer, diverticular disease, inflammatory bowel disease, celiac disease, and other functional gastrointestinal disorders follows." "Celiac disease Doctors in the north of England and ireland report that many patients with a diagnoses of IBS have celiac disease, a chronic small intestinal malabsorbtion state due to sensitvity to wheat protein. These reports are from areas where the prevalance of Celiac disease is relatively high. While the dat have less relavance elsewhere, they do underline your doctors need to consider a person's ethnicity, and other personal characteristics when making a diagnoses. As in the above diseases, the association with IBS is likely coincidental, even in England and ireland. Nevertheless, it would be foolish not to considered seriously a disease that is common in a community or ethnic group. As with IBD, IBS symptoms may accompany celiac disease, but no evidence supports the notion that IBS makes one prone to aquire it." http://www.aboutibs.org/Publications/currentParticipate.htmlIBS diagnoses -------------------------------------------------------------------------------- From Medscape Gastroenterology Irritable Bowel Syndrome Expert Column IBS: Challenges in Diagnosis Posted 09/22/2003 M. Brian Fennerty, MD Introduction Irritable bowel syndrome (IBS) is a prevalent, chronic, and morbid disease that traditionally has been underappreciated.[1] The prevalence of IBS in western populations is approximately 10% to 15%, and in most patients, IBS results in intermittent but persistent symptoms. More importantly, the symptoms associated with IBS result in a significant decrease in that patient's quality of life and, furthermore, result in increased healthcare resource utilization and, therefore, increased cost of caring for these patients. Despite IBS being a common disease that has been extensively evaluated, there is as yet no specific diagnostic test for the disorder. Instead, the diagnosis of IBS is still based on the presence of specific gastrointestinal symptoms of a minimum duration along with an absence of other gastrointestinal pathology that would explain those symptoms. A number of symptom-based criteria for the diagnosis of IBS have been devised to assist with the diagnosis of this disorder. Furthermore, there have been a variety of recommendations regarding the appropriate clinical work-up for patients thought to have IBS. This review focuses on currently accepted criteria for IBS, including an evidence-based recommendation regarding the appropriate diagnostic evaluation for patients suspected of having this disorder. Symptom-Based Criteria for the Diagnosis of IBS IBS is defined as a symptom complex for which the pathophysiologic basis is as yet unclear (eg, is it a perturbation in serotonin receptor function, an abnormality of motility or perception, or a combination of factors?). As such, there is still no biologic "marker" for this disorder and the diagnosis of IBS is therefore not based on the documentation of a specific physiologic aberration or anatomic defect, but rather on the ascertainment of specific symptoms in a patient presenting with abdominal discomfort and altered bowel habits. What is important to realize is that in all of the diagnostic criteria currently used (see below), the presence of abdominal discomfort remains an absolute criterion for the diagnosis. In other words, altered defecation without accompanying discomfort is not IBS, and so another pathology must be sought. The first widely used symptom-based diagnostic criteria for IBS were those proposed by Manning and colleagues (and now known as the Manning criteria).[2] According to this diagnostic scheme, symptoms of IBS include abdominal pain that is relieved with defecation, and looser stool with the onset of the discomfort. Included in these criteria were abdominal distension, presence of a mucoid rectal discharge, and a sensation of incomplete evacuation of stool. In an effort to improve the utility of symptom-based criteria for the diagnosis of IBS, especially with regard to their utility for entering patients into clinical studies of the disorder, a group of investigators and experts on functional gastrointestinal disorders met and proposed a new set of criteria, now known as the Rome criteria.[3] This diagnostic scheme also emphasized the presence of abdominal discomfort, but further included a statement regarding the chronic nature of the symptoms. Additionally, integral to this new diagnostic scheme was the presence of altered bowel function that accompanied the abdominal discomfort. Because these criteria were still not necessarily adaptable to clinical practice and many experts discounted the utility of the subclassification of IBS suggested by this scheme, a new set of criteria were proposed.[4] These new criteria, the "Rome II" criteria (Table), can be simplified and summarized as follows: the presence of abdominal discomfort for at least 3 months in the past year along with either symptom relief with defecation, onset associated with a change in frequency of defecation, or onset associated with a change in form of stool. What is clear from all of these above diagnostic criteria is the following: First, these criteria remain unwieldy and, although useful in ensuring similar patients are enrolled in clinical research studies, they are much less useful as a diagnostic tool in clinical practice. Second, all of these diagnostic schemes have emphasized the presence of "abdominal discomfort that is associated with altered bowel function." This later abbreviated and simplified synthesis of the more complex preceding diagnostic criteria may represent a more clinically useful "tool" for identifying the patient with IBS. Because of limitations to any of the existing diagnostic criteria, it is expected that "Rome III" will soon need to be developed. Recommended Diagnostic Evaluation of Patients With Suspected IBS The differential diagnosis of a patient initially presenting with symptoms diagnostic of IBS is extensive and includes a number of gastrointestinal disease processes, such as inflammatory bowel disease, colorectal neoplasia, gluten-sensitive enteropathy, chronic giardiasis, etc. Because of the possibility that these or other potentially serious diseases could masquerade as IBS, many experts have recommended a wide variety of diagnostic tests be performed in patients fulfilling the symptom criteria for IBS before a definitive diagnosis of IBS is made (ie, IBS is a diagnosis of exclusion, not inclusion). Examples of some of these tests routinely recommended in a patient with suspected IBS include a complete blood count and erythrocyte sedimentation rate, stool studies for ova and parasites, sigmoidoscopy with rectal biopsy and/or a barium enema or colonoscopy, a small bowel study, chemistry panels, thyroid function tests, sprue antibodies, and a host of other "screening" tests.[5-9] However, before embarking on a search for other potential disease states in a patient thought to have IBS, the clinician needs to know the likelihood or possibility that disease could be present in a patient presenting with these symptoms -- that is, what is the pretest possibility of that disease being present?[1] A number of studies have assessed the prevalence of other gastrointestinal diseases in patients fulfilling the above symptom-based diagnostic criteria for IBS.[5-1 There are a number of limitations to these studies, but despite this deficiency, a central theme exists in all of these data: there are still no data that support the routine performance of any diagnostic test in patients fulfilling the symptom criteria for IBS. The exception to this conclusion is the suggestion from a single study that celiac sprue may be more prevalent in a suspected IBS population, and this observation may then support the use of screening antibody tests for sprue when such possibility exists.[1 An important caveat to the current recommendation to not perform any further diagnostic testing in patients with suspected IBS is that patients with symptoms of IBS who also present with any of the "so-called" alarm symptoms (fever, anemia, weight loss, rectal bleeding) may have a greater likelihood of other pathology, and in these select few patients, additional organ-specific testing may be appropriate and is still recommended.[1] This is especially true for older patients (> 50 years of age), in whom colorectal neoplasia has to be considered as a possibility for those presenting with new bowel symptoms or new alarm symptoms. Recommended Approach for the Diagnosis of IBS In most cases, the diagnosis of IBS should be a positive diagnosis based on symptoms alone, and so routine diagnostic testing in patients thought to have the disorder cannot be justified or recommended on the basis of existing data.[1] In patients presenting with abdominal pain or discomfort associated with bloating and constipation, diarrhea, or alternating diarrhea and constipation, there should rarely be a need for further diagnostic testing, and thus, a positive diagnosis of IBS can be confidently made. However, one should look for "red flags" or alarm symptoms that may be detected in a careful history and physical exam. Patients with symptoms of IBS and coexistent rectal bleeding, weight loss, or older age at presentation should undergo appropriate additional diagnostic testing (ie, colonoscopy in those with rectal bleeding and age older than 50 years, sprue antibody tests in younger patients with weight loss and diarrhea). The key to the diagnostic approach in patients with suspected IBS is to be selective in the use of any ancillary tests other than a history and physical exam. A positive diagnosis of IBS can and should be made on the basis of the typical clinical presentation, and a treatment plan should be initiated according to the presenting symptom pattern without the need to await further testing. http://www.medscape.com/viewarticle/461605


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