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 16 December 2017

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News

Screening for celiac disease in IBS

The latest issue of the American Journal of Gastroenterology reviews guidelines that recommend screening individuals with IBS for celiac disease.

News image

Celiac disease and irritable bowel syndrome (IBS) share similar symptoms, leading to confusion between the two and diagnostic delay.

International guidelines recommend screening individuals with IBS for celiac disease, via serological testing.

However, studies published recently have cast doubt on the utility of this.

Professor Alexander Ford and colleagues from the United Kingdom updated a previous meta-analysis examining this issue.

MEDLINE, EMBASE, and EMBASE Classic were searched through to 2016.

Eligible studies recruited adults with IBS according to symptom-based criteria, physician’s opinion, or questionnaire data.

The pooled odds ratio for positive IgA-class antigliadin antibodies and celiac disease was 3.2
American Journal of Gastroenterology

Tests for celiac disease included IgA-class antigliadin antibodies, endomysial antibodies, tissue transglutaminase antibodies, or duodenal biopsies following positive serology.

The team combined the proportion of individuals meeting criteria for IBS testing positive for celiac disease to give a pooled prevalence for all studies, and compared between cases with IBS and, healthy controls without.

There were 36 eligible studies, recruiting 15,256 individuals, of whom 61% met criteria for IBS.

The researchers found that the pooled odds ratio for positive IgA-class antigliadin antibodies, endomysial antibodies and/or tissue transglutaminase antibodies, and biopsy-proven celiac disease in IBS subjects vs. controls were 3.2, 2.8, and 4.5, respectively.

The research team found no increase in odds ratio for any test for celiac disease among cases with IBS in North American studies, and results were inconsistent in population-based studies.

The researchers noted that the prevalence of biopsy-proven celiac disease was significantly higher across all subtypes of IBS.

Limitations included heterogeneity in some analyses, and few North American studies.

Professor Ford's team concludes, "Overall, prevalence of positive celiac serology and biopsy-proven celiac disease was significantly higher in subjects with symptoms suggestive of IBS vs. healthy controls."

"However, the utility of screening for celiac disease in individuals with suspected IBS in North America or in the community is less clear."

Am J Gastroenterol 2017; 112:65–76
05 January 2017

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