The prevalence of celiac disease among patients with nonconstipated irritable bowel syndrome is similar to controls

Gastroenterology. 2011 Oct;141(4):1187-93. doi: 10.1053/j.gastro.2011.06.084. Epub 2011 Jul 14.

Abstract

Background & aims: Guidelines recommend that patients with symptoms of nonconstipated irritable bowel syndrome (NC-IBS) undergo testing for celiac disease (CD). We evaluated the prevalence of CD antibodies, and biopsy confirmed CD among patients with NC-IBS in a large US population.

Methods: In a study conducted at 4 sites, from 2003 to 2008, we compared data from 492 patients with symptoms of NC-IBS to 458 asymptomatic individuals who underwent colonoscopy examinations for cancer screening or polyp surveillance (controls). All participants provided blood samples for specific and nonspecific CD-associated antibodies. Additionally, patients with IBS were analyzed for complete blood cell counts, metabolic factors, erythrocyte sedimentation rates, and levels of C-reactive protein and thyroid-stimulating hormone. Any subjects found to have CD-associated antibodies were offered esophagogastroduodenoscopy and duodenal biopsy analysis.

Results: Of patients with NC-IBS, 7.3% had abnormal results for CD-associated antibodies, compared with 4.8% of controls (adjusted odds ratio, 1.49; 95% confidence interval: 0.76-2.90; P=.25). Within the NC-IBS group, 6.51% had antibodies against gliadin, 1.22% against tissue transglutaminase, and 0.61% against endomysium (P>.05 vs controls for all antibodies tested). CD was confirmed in 0.41% of patients in the NC-IBS group and 0.44% of controls (P>.99).

Conclusions: Although CD-associated antibodies are relatively common, the prevalence of CD among patients with NC-IBS is similar to that among controls in a large US population. These findings challenge recommendations to routinely screen patients with NC-IBS for CD. More than 7% of patients with NC-IBS had CD-associated antibodies, suggesting that gluten sensitivity might mediate IBS symptoms; further studies are needed.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Webcast

MeSH terms

  • Adult
  • Autoantibodies / blood
  • Biopsy
  • Case-Control Studies
  • Celiac Disease / diagnosis
  • Celiac Disease / epidemiology*
  • Celiac Disease / immunology
  • Celiac Disease / pathology
  • Chi-Square Distribution
  • Colonoscopy
  • Duodenum / pathology
  • Female
  • GTP-Binding Proteins
  • Gliadin / immunology
  • Humans
  • Irritable Bowel Syndrome / diagnosis
  • Irritable Bowel Syndrome / epidemiology*
  • Irritable Bowel Syndrome / pathology
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Prevalence
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Transglutaminases / immunology
  • United States / epidemiology

Substances

  • Autoantibodies
  • Gliadin
  • transglutaminase 2
  • Transglutaminases
  • GTP-Binding Proteins