How Can Doctors Better Screen IBS and Celiac Patients?

Celiac.com 12/15/2016 - Celiac disease and irritable bowel syndrome (IBS) can have similar symptoms, and confusion between the two can often cause delays in diagnosis. International guidelines recommend screening IBS patients for celiac disease using serological testing. However, studies published recently have cast doubt on the utility of this.

A team of researchers recently set out to assess the use of serological testing to screen IBS patients for celiac disease, and to update a previous meta-analysis of this issue. The research team included Andrew J Irvine, William D Chey and Alexander C Ford. They searched MEDLINE, EMBASE, and EMBASE Classic through May 2016, looking for studies that had recruited adults with IBS according to symptom-based criteria, physician's opinion, or questionnaire data.

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Tests for celiac disease included IgA-class antigliadin antibodies (AGA), endomysial antibodies (EMA), tissue transglutaminase antibodies (tTG), or duodenal biopsies following positive serology. They combined the proportion of individuals meeting criteria for IBS, and testing positive for celiac disease, to give a pooled prevalence for all studies, and they then compared between cases with IBS and, where reported, healthy controls without IBS, using an odds ratio (OR) with a 95% confidence interval (CI).

They found a total of thirty-six eligible studies, and 15,256 participants, nearly sixty-one percent of whom met criteria for IBS. Pooled ORs for positive IgA AGAs, EMA and/or tTG, and biopsy-proven celiac disease in IBS subjects vs. controls were 3.21 (95% CI 1.55–6.65), 2.75 (95% CI 1.35–5.61), and 4.48 (95% CI 2.33–8.60), respectively.

The authors wrote that there was "no increase in ORs for any test for celiac disease among cases with IBS in North American studies, and results were inconsistent in population-based studies."

Rates of biopsy-proven celiac disease were substantially higher across all subtypes of IBS. Their review had a few limitations, including heterogeneity in some analyses, along with limited North American study data.

Overall, people with symptoms suggestive of IBS had higher rates of positive celiac serology and biopsy-proven celiac disease than did healthy control subjects. However, the case for celiac disease screening for individuals with suspected IBS in North America is still unclear. Essentially, we need broader and more comprehensive study of this issue in North America.

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