Celiac Disease-Like Abnormalities in a Subgroup of Patients With Irritable Bowel Syndrome

Gastroenterology. 2001 Dec;121(6):1329-38. doi: 10.1053/gast.2001.29572.

Abstract

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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies / analysis
  • Antigens / immunology
  • Celiac Disease / complications*
  • Celiac Disease / immunology
  • Colonic Diseases, Functional / complications*
  • Colonic Diseases, Functional / immunology
  • Diet
  • Duodenum / immunology
  • Female
  • Gliadin / immunology
  • Humans
  • Immunoglobulin A / analysis
  • Immunoglobulin M / analysis
  • Lactoglobulins / immunology
  • Male
  • Middle Aged
  • Ovalbumin / immunology
  • Reticulin / immunology
  • Transglutaminases / immunology

Substances

  • Antibodies
  • Antigens
  • Immunoglobulin A
  • Immunoglobulin M
  • Lactoglobulins
  • Reticulin
  • Ovalbumin
  • Gliadin
  • Transglutaminases