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    How Can Doctors Better Screen IBS and Celiac Patients?


    Jefferson Adams
    Image Caption: Photo: CC--Theilr

    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.


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    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.

    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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  • About Me

    Jefferson Adams is a freelance writer living in San Francisco. He has covered Health News for Examiner.com, and provided health and medical content for Sharecare.com. His work has appeared in Antioch Review, Blue Mesa Review, CALIBAN, Hayden's Ferry Review, Huffington Post, the Mississippi Review, and Slate, among others.

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  • Related Articles

    Jefferson Adams
    Celiac.com 12/30/2013 - Irritable bowel syndrome (IBS) and fibromyalgia syndrome (FMS) often occur together, and research indicates that many people with IBS plus FMS (IBS/FMS) might actually suffer from undiagnosed celiac disease.
    To better understand the potential connection between the two, a team of researchers recently conducted an active case finding for celiac disease in two IBS cohorts, one constituted by IBS/FMS subjects and the other by people with isolated IBS.
    The research team included L. Rodrigo, I. Blanco, J. Bobes, F.J. de Serres. They are affiliated with the department of Gastroenterology at the Central University Hospital of Asturias (HUCA), Celestino Villamil in Oviedo in the Principality of Asturias, Spain.
    For their study, the team included 104 patients (89.4% females), fulfilling the 1990-ACR criteria for FMS and the Roma III criteria for IBS classification, along with 125 unrelated, age and sex matched IBS non-FMS patients.
    All patients underwent the following studies: hematological, coagulation and biochemistry test, serological and genetic markers for celiac disease (i.e., tissue-Transglutaminase-2, tTG-2, and major histocompatibility complex HLA-DQ2/DQ8); multiple gastric and duodenal biopsies; FMS tender points (TPs); fibromyalgia impact questionnaire (FIQ), health assessment questionnaire (HAQ), short form health survey (SF-36), and visual analogue scales (VAS) for tiredness and gastrointestinal complaints.
    Overall results showed that IBS/FMS patients scored much worse values in quality of life and VAS scales than those with isolated IBS (p
    These seven patients showed substantial improvement in digestion and symptoms once they adopted gluten-free diets.
    The findings of this screening indicate that a significant percentage of IBS/FMS patients actually have celiac disease. These patients can improve symptoms and possibly prevent long-term celiac-related complications with a strict lifelong gluten-free diet.

    Source:
    Arthritis Res Ther. 2013 Nov 27;15(6):R201.

    Jefferson Adams
    Celiac.com 06/23/2014 - Previous studies of adults have shown a strong connection between celiac disease and irritable bowel syndrome, but there has been very little data for children.
    A research team recently set out to determine rates of celiac disease in children with ongoing abdominal pain.
    The researchers included Fernanda Cristofori, MD; Claudia Fontana, MD; Annamaria Magistà, MD; Teresa Capriati, MD; Flavia Indrio, MD; Stefania Castellaneta, MD; Luciano Cavallo, MD; Ruggiero Francavilla, MD, PhD.
    They are variously affiliated with the Interdisciplinary Department of Medicine, Pediatric Section at the University of Bari ’s Giovanni XXIII Hospital in Bari, Italy, the Department of Pediatrics at Ravenna Hospital in Ravenna, Italy, and the Department of Pediatrics at San Paolo Hospital in Bari, Italy.
    For their prospective observational study, the team tested 782 children who presented with abdominal pain-related disorders, 270 with IBS, 201 with functional dyspepsia, and 311 with functional abdominal pain. All subjects were treated between 2006 and 2012 at the university hospital of Bari, the regional tertiary referral center for gastrointestinal disorders.
    As a primary screen for celiac disease, the researchers used serum tests for immunoglobulin A, immunoglobulin A antitissue transglutaminase, and endomysial antibodies. They then confirmed the diagnosis with upper endoscopy, including multiple duodenal biopsies.
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    Source:
     JAMA Pediatrics. Published online April 21, 2014.

    Jefferson Adams
    Celiac.com 06/04/2015 - Some researchers feel that people who self report non-celiac gluten sensitivity (SR-NCGS) and also follow a gluten-free diet might actually fall within the spectrum of irritable bowel (IBS). Interestingly, recent reports suggest that large numbers of people with inflammatory bowel disease (IBD) also follow a gluten-free diet.
    A research team recently assessed the relationship between IBD and self-reported non-celiac gluten sensitivity (SR-NCGS). The team included I.Aziz, F. Branchi, K. Pearson, J. Priest, and D.S. Sanders. They are variously affiliated with the Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom; and the Gastroenterology and Endoscopy Unit in the Department of Pathophysiology and Transplantation at the Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplant, Università degli Studi di Milano in Milan, Italy.
    To screen for SR-NCGS and the use of a GFD, they used a cross-sectional questionnaire in 4 groups: ulcerative colitis (n = 75), Crohn's disease (n = 70), IBS (n = 59), and dyspeptic controls (n = 109). They also looked at diagnostic outcomes for IBD in 200 patients presenting with SR-NCGS.
    A total of 25 out of 59 patients with IBS (42.4%), and 40 out of 145 patients (27.6%) with IBD reported SR-NCGS. That number was just 19 of 109 for dyspeptic control subjects (17.4%). As far a gluten-free diet, currently, 11.9% of patients with IBS, and 6.2% of those with IBD are following a gluten-free diet, as compared with just 0.9% for dyspeptic controls; P = 0.02.
    For the purposes of of this study, the team made no differences between ulcerative colitis and Crohn's disease. However, 40.9% of Crohn's disease patients with SR-NCGS suffered from stricturing disease, compared with 18.9% for Chrohn's patients without SR-NCGS; (P = 0.046). Crohn's disease patients with SR-NCGS showed higher overall scores on the Crohn's Disease Activity Index (228.1 versus 133.3, P = 0.002) than those without SR-NCGS.
    The team analyzed 200 cases presenting with SR-NCGS, and found that 197 of them, or 98.5% were most likely diet-related IBS. However, 3 of the SR-NCGS patients (1.5%) actually had IBD, with all of the associated alarm symptoms, and/or abnormal blood parameters.
    The results show that SR-NCGS is not exclusive to IBS, but is also seen in some patients with IBD, which is a more severe, more debilitating condition.
    The team is calling for randomized studies to further delineate the nature of this relationship and clarify whether a gluten-free is appropriate for certain IBD patients.

    Source:
    Inflamm Bowel Dis. 2015 Apr;21(4):847-53. doi: 10.1097/MIB.0000000000000335.

    Jefferson Adams
    Celiac.com 07/29/2015 - Numerous studies have shown that a high percentage of patients with irritable bowel syndrome (IBS) are also sensitive to gluten. 
    A team of researchers recently set out to evaluate the effect of a gluten-free diet on gastrointestinal symptoms in patients with IBS. The research team included B. Shahbazkhani, A. Sadeghi, R. Malekzadeh, F. Khatavi, M. Etemadi, E. Kalantri, M. Rostami-Nejad, and K. Rostami.
    They are variously affiliated with the Gastroenterology Unit of Imam Khomeini Hospital at the Tehran University of Medical Sciences, Tehran, Iran, the Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran, the Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Clinic, Tehran, Iran, the Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran, the Gholhak Medical Laboratory, Tehran, Iran, the Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran, and with the Department of Gastroenterology, Alexandra Hospital, Worcestershire, UK.
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    Unfortunately, only 72 out of the 148 remained on a gluten-free diet for the six weeks needed to complete the study.
    The team recorded clinical symptoms biweekly using a standard visual analogue scale (VAS).
    In the second stage after six weeks, patients whose symptoms improved to an acceptable level were randomly divided into two groups; The first group of 35 patients received packages containing powdered gluten, while 37 patients received a gluten-free placebo powder.
    Nearly 84% of the gluten-free placebo group showed a significant improvement in symptoms compared to just under 26% for the gluten consuming group (p < 0.001).
    This study confirms that a large number of patients diagnosed with irritable bowel syndrome are sensitive to gluten.
    The team suggests that the term of IBS might be misleading and may change or delay an "effective and well-targeted treatment strategy in gluten sensitive patients."
    Source:
    Nutrients. 2015 Jun 5;7(6):4542-54. doi: 10.3390/nu7064542.

  • Recent Articles

    Christina Kantzavelos
    Celiac.com 07/20/2018 - During my Vipassana retreat, I wasn’t left with much to eat during breakfast, at least in terms of gluten free options. Even with gluten free bread, the toasters weren’t separated to prevent cross contamination. All of my other options were full of sugar (cereals, fruits), which I try to avoid, especially for breakfast. I had to come up with something that did not have sugar, was tasty, salty, and gave me some form of protein. After about four days of mixing and matching, I was finally able to come up with the strangest concoction, that may not look the prettiest, but sure tastes delicious. Actually, if you squint your eyes just enough, it tastes like buttery popcorn. I now can’t stop eating it as a snack at home, and would like to share it with others who are looking for a yummy nutritious snack. 
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    Jefferson Adams
    Celiac.com 07/19/2018 - Maintaining a gluten-free diet can be an on-going challenge, especially when you factor in all the hidden or obscure gluten that can trip you up. In many cases, foods that are naturally gluten-free end up contain added gluten. Sometimes this can slip by us, and that when the suffering begins. To avoid suffering needlessly, be sure to keep a sharp eye on labels, and beware of added or hidden gluten, even in food labeled gluten-free.  Use Celiac.com's SAFE Gluten-Free Food List and UNSAFE Gluten-free Food List as a guide.
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    Jefferson Adams
    Celiac.com 07/18/2018 - Despite many studies on immune development in children, there still isn’t much good data on how a mother’s diet during pregnancy and infancy influences a child’s immune development.  A team of researchers recently set out to assess whether changes in maternal or infant diet might influence the risk of allergies or autoimmune disease.
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    They are variously associated with the Department of Undiagnosed Celiac Disease More Common in Women and Girls International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America; the Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom; the Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom; the Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom; the Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom; the Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, United Kingdom; and Stanford University in the USA.
    Team members searched MEDLINE, Excerpta Medica dataBASE (EMBASE), Web of Science, Central Register of Controlled Trials (CENTRAL), and Literatura Latino Americana em Ciências da Saúde (LILACS) for observational studies conducted between January 1946 and July 2013, and interventional studies conducted through December 2017, that evaluated the relationship between diet during pregnancy, lactation, or the first year of life, and future risk of allergic or autoimmune disease. 
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    The team found less evidence, and low GRADE certainty, for claims that breastfeeding reduces eczema risk during infancy, that longer exclusive breastfeeding is associated with reduced type 1 diabetes mellitus, and that probiotics reduce risk of infants developing allergies to cow’s milk. 
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    Stay tuned for more on diet during pregnancy and its role in celiac disease.
    Source:
    PLoS Med. 2018 Feb; 15(2): e1002507. doi:  10.1371/journal.pmed.1002507

    Jefferson Adams
    Celiac.com 07/17/2018 - What can fat soluble vitamin levels in newly diagnosed children tell us about celiac disease? A team of researchers recently assessed fat soluble vitamin levels in children diagnosed with newly celiac disease to determine whether vitamin levels needed to be assessed routinely in these patients during diagnosis.
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    Source:
    BMC Pediatrics

    Jefferson Adams
    Celiac.com 07/16/2018 - Did weak public oversight leave Arizonans ripe for Theranos’ faulty blood tests scam? Scandal-plagued blood-testing company Theranos deceived Arizona officials and patients by selling unproven, unreliable products that produced faulty medical results, according to a new book by Wall Street Journal reporter, whose in-depth, comprehensive investigation of the company uncovered deceit, abuse, and potential fraud.
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    SEC recently charged the now disgraced Holmes with what it called a 'years-long fraud.’ The company’s value has plummeted, and it is now nearly worthless, and facing dozens, and possibly hundreds of lawsuits from angry investors. Meantime, Theranos will pay Arizona consumers $4.65 million under a consumer-fraud settlement Arizona Attorney General Mark Brnovich negotiated with the embattled blood-testing company.
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    Read more at azcentral.com.