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  • Jefferson Adams
    Jefferson Adams

    People with Irritable Bowel Syndrome Don't Usually Have Celiac Disease

      A new study suggests that celiac disease is uncommon in people with irritable bowel syndrome, so there's no need for routine celiac testing in IBS patients.

    Caption: Bloated. Image: CC--stephen boisevert

    Celiac.com 03/12/2019 - Some doctors routinely conduct celiac testing in irritable bowel syndrome (IBS) patients, but it is not currently accepted practice.  A team of researchers recently set out to compare the rates of undiagnosed celiac disease in a large group of patients both with and without IBS.

    The research team included AE Almazar, NJ Talley, JJ Larson, EJ Atkinson, JA Murray, and YA Saito. They are variously affiliated with the Department of Medicine, the Division of Gastroenterology and Hepatology,  the Department of Health, Division of Biomedical Statistics and Informatics, and the Department of Immunology at the Mayo Clinic in Rochester, Minnesota, USA, and with the Faculty of Health and Medicine at the University of Newcastle in Callaghan, New South Wales, Australia.

    The team performed their family case-control IBS study at a single US academic medical center. They accessed serum and DNA, and conducted tissue transglutaminase (TTg) immunoglobulin A, followed by indirect immunofluorescence testing for endomysial antibodies with positive or weakly positive TTg results. 

    The team defined patients with celiac disease only when both results were positive. They used χ and Fisher's exact tests to compare celiac rates between the two groups. The team looked at serum samples for 533 cases and 531 control subjects. Eighty percent of study subjects were women, with a median age of 50 years. A total of 65% of cases and none of the control subjects met the Rome criteria for IBS. 

    Overall, the team found no difference in rates of celiac disease between patients with IBS and patients without IBS. Based on these results, the researchers see no need for universal celiac serologic or genetic testing in patients with IBS. Stay tuned for more information on IBS and other issues related to celiac disease.

    Read more at: Eur J Gastroenterol Hepatol. 2018 Feb;30(2):149-154. doi: 10.1097/MEG.0000000000001022.



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    This concerns me. As I was diagnosed as IBS by symptoms only (no testing) for over 20 plus years. I am a DH  celiac who had GI issues My entire life and numerous waxing waning celiac symptoms through out life. In the end the Dr confirmed no gluten for me ( misdiagnosed IBS decades ) and there was no signs to indicate/confirm IBS.

    I have concerns for misdiagnosed Celiac's out there that maybe  currently labeled IBS. I was missed too many times upon reflection it's riduculous. 

    Best wishes to everyone so that my story is hopefully rare.

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    On 3/17/2019 at 2:13 PM, Awol cast iron stomach said:

    This concerns me. As I was diagnosed as IBS by symptoms only (no testing) for over 20 plus years. I am a DH  celiac who had GI issues My entire life and numerous waxing waning celiac symptoms through out life. In the end the Dr confirmed no gluten for me ( misdiagnosed IBS decades ) and there was no signs to indicate/confirm IBS.

    I have concerns for misdiagnosed Celiac's out there that maybe  currently labeled IBS. I was missed too many times upon reflection it's riduculous. 

    Best wishes to everyone so that my story is hopefully rare.

    This concerns me too.   In 2007, my 1st gastro specialist didn't even to bother ordering bloodwork, went straight to colonoscopy. When it came back clean, he said IBS.  He also said, well, it could be celiac, but you're overweight, so nope, we're not even gonna test you for it.  I had so many of the symptoms it's not even funny.  Fast forward to 2011, my symptoms had gotten worse, and surprise, bloodwork for celiac came back very positive.  Endoscopy confirmed it.  And going gluten free saved me.  I know I'm not alone in this type of experience.  Not enough people are tested for celiac disease.  I had symptoms starting in adolescence that got pretty bad in my 20's, and still didn't get diagnosed until I was 33, despite reporting my issues to various doctors for many years.  I just hope the awareness of this disease continues to spread.

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    I agree. There are so many people I've heard that got misdiagnosed with IBS when it was really Celiac (including myself), that I feel like articles and studies like this make it even less likely that the mistake will be found. Maybe someone who ACTUALLY has IBS is less likely to have Celiac, but what about all the people who doctors write off as IBS that aren't? I think Celiac screening should be a go-to for people who manifest with persistent digestive issues (especially if that person has two other auto-immune diseases - duh!) I was told IBS for years, and after a conversation with a co-worker who had Celiac, I did some research and essentially diagnosed myself. I had to insist on the testing, like the earlier poster, I was overweight so the Dr thought it was impossible. There is so much misunderstanding out there; this is just going to feed the resistance to keep looking for a cause.

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    8 hours ago, Guest ThisIsKate said:

    This concerns me too.   In 2007, my 1st gastro specialist didn't even to bother ordering bloodwork, went straight to colonoscopy. When it came back clean, he said IBS.  He also said, well, it could be celiac, but you're overweight, so nope, we're not even gonna test you for it.  I had so many of the symptoms it's not even funny.  Fast forward to 2011, my symptoms had gotten worse, and surprise, bloodwork for celiac came back very positive.  Endoscopy confirmed it.  And going gluten free saved me.  I know I'm not alone in this type of experience.  Not enough people are tested for celiac disease.  I had symptoms starting in adolescence that got pretty bad in my 20's, and still didn't get diagnosed until I was 33, despite reporting my issues to various doctors for many years.  I just hope the awareness of this disease continues to spread.

    Yes,  very concerning indeed. I had had a colonoscopy even after I was diagnosed IBS symptoms only for over a decade. No endoscopy until 2016. By then my cousin was diagnosed a gold standard celiac she also was also sick with GI issues for decades. 

    So while not every IBS is celiac in my opinion quite a few celiac's are currently or have been misdiagnosed IBS in past. We are hitting middle-age and finally some Dr's are saying wait your diagnosed IBS on  symptoms  only? You didn't get both scopes ?  Those are the ones showing us celiac is not the rare rigid disease, but a more complex diagnosis often misdiagnosis. To those Dr's thanks .

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

  • Related Articles

    Jefferson Adams
    Celiac.com 06/06/2016 - Irritable Bowel Syndrome (IBS) is one of the most common types of functional bowel disorder. As researchers attempt to unravel the mysteries behind IBS, they have payed increasing attention to the possible impact of food and diet.
    For many people with IBS, certain foods seem to trigger or worsen symptoms, such as abdominal pain and bloating. Wheat is suspected as a major IBS trigger, although which exact aspects of wheat might be involved is not yet known. Gluten, and other wheat proteins, such as amylase-trypsin inhibitors, and fructans, which belong to fermentable oligo-di-mono-saccharides and polyols (FODMAPs), have been identified as possible factors for triggering or worsening IBS symptoms.
    A research team recently set out to examine the issue, especially with respect to gluten and FODMAP sensitivity. The research team included Roberto De Giorgio, Umberto Volta, and Peter R Gibson. They are variously affiliated with the Department of Medical and Surgical Sciences, Centro di Ricerca Bio-Medica Applicata (C.R.B.A.) and Digestive System, St. Orsola-Malpighi Hospital at the University of Bologna in Bologna, Italy, and the Department of Gastroenterology Alfred Hospital at Monash University in Melbourne, Australia.
    The researchers suspect that sensitivity occurs through different mechanisms, including immune and mast cell activation, mechanoreceptor stimulation and chemosensory activation. The lack of certainty regarding the actual triggers has opened a scenario of semantic definitions favored by the discordant results of double-blind placebo-controlled trials, which have generated various terms ranging from non-coeliac gluten sensitivity to the broader one of non-coeliac wheat or wheat protein sensitivity or, even, FODMAP sensitivity.
    The role of FODMAPs in eliciting the clinical picture of IBS goes further since these short-chain carbohydrates are found in many other dietary components, including vegetables and fruits.
    In their review, they assessed current literature in order to unravel whether gluten/wheat/FODMAP sensitivity represent 'facts' and not 'fiction' in IBS symptoms.
    This knowledge is expected to promote standardization in dietary strategies, especially gluten/wheat-free and low FODMAP diets, as suitable ways to manage IBS symptoms.
    Read more at: Gut. doi:10.1136/gutjnl-2015-309757



    Jefferson Adams
    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.
    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.
    Source:
    The American Journal of Gastroenterology, 18 October 2016. doi:10.1038/ajg.2016.466

    Dr. Vikki Petersen D.C, C.C.N
    Celiac.com 02/23/2017 - IBS, also known as Irritable Bowel Syndrome, is a miserable condition. If you've ever had food poisoning or experienced Montezuma's revenge from travel, you have a good idea of how someone who suffers from IBS may feel. But while your food poisoning passed in a couple of days, imagine what it would be like to live like that each and every day.
    You have loose bowel movements anywhere from 4 to 20 times per day. And often they are so urgent that making it to the bathroom is not always possible. You don't need to think about that scenario for long to realize why patients with IBS often choose not to venture far from home. They can literally become ‘house bound' by this condition.
    The chronic diarrhea often switches to constipation for several days before the diarrhea resumes, but they rarely have ‘normal bowel function'. Imagine if you were diagnosed with this condition. You would want to know the treatment and, hopefully, the cure. Most doctors will tell you that there is no cure. They'll also start talking to you about your stress levels. Do you think it's more common for the stress to precede IBS or to be a result of it? Do you think it's at all stressful to never know when you'll next need to ‘dash' to the restroom? Do you think it's at all stressful to constantly have to contemplate what it would be like if you DIDN'T successfully make it to the restroom?
    Yes, in my experience I do find that in the vast majority of cases the stress is secondary to the condition, not primary. That's my experience, but I also haven't met a case of IBS that I haven't cured – providing the patients were compliant, of course.
    If you look online, this is what ‘WebMD' has to say about the condition:
    "Although there currently is no cure for IBS, careful attention to diet and stress management should help keep your symptoms under control and perhaps even prevent them from coming back."
    "In many people who have IBS, eating may trigger symptoms. But for most people, there is not a particular type of food that triggers symptoms."
    "Increasing the amount of fiber in your diet can help control constipation. High-fiber foods include fresh fruits (raspberries, pears, apples), fresh vegetables (peas, brussels sprouts), wheat bran, and whole-grain breads and cereals. Beans such as kidney, pinto, and garbanzo are also high-fiber foods, but they should probably be avoided if gas is one of your symptoms."
    "You can take steps to reduce the possibility that certain foods will cause symptoms, such as avoiding or limiting gas-producing foods (including beans and cabbage), sugarless chewing gum and candy, caffeine, and alcohol."
    Okay. So according to them you should eat wheat bran, but you should avoid beans and cabbage. To say I disagree would be an understatement. I personally have not met a single person with IBS who wasn't gluten intolerant and I have never found anyone with this ailment who couldn't eat some beans and cabbage. Gas is a result of poorly digested food. The cause isn't typically the ‘gassy' food, but rather a food intolerance that is creating stress on the small intestine, resulting in a compromised ability to produce enzymes and properly digest food. Gassiness is an easy symptom to cure, but avoiding beans and cabbage is not typically the answer.
    Let's look at some recent research that shines some light on this topic: Just last month Gastroenterology published an article entitled ‘A Controlled Trial of Gluten-Free Diet in Patients with Irritable Bowel Syndrome-Diarrhea: Effects on Bowel Frequency and Intestinal Function'. This study was performed by a team of doctors at the Mayo Clinic.
    Their goal was to discover whether IBS patients with diarrhea as their predominant symptom could benefit from a gluten-free diet. They performed genetic testing for celiac genes on 45 IBS patients who fit their criteria. Twenty-two patients were put in the gluten containing diet group, while twenty-three were put into the gluten-free group. In each group, 50% had the celiac genes and 50% of the group did not.
    Bowel function (number of bowel movements) and permeability, as well as the production of inflammatory chemicals were measured. Those on the gluten containing diet had more bowel movements per day, with the greater number seen in those positive for the celiac gene. So too was intestinal permeability (leaky gut) more prevalent in those consuming gluten and positive for the celiac gene.
    While effects of gluten were certainly stronger in those with the celiac gene, even those without the gene were affected when compared to the gluten-free group.
    The authors' conclusion was that gluten alters bowel barrier function in IBS patients with predominant diarrhea, particularly among those who carry the celiac gene. They concluded with this statement: "These findings reveal a reversible mechanism for the disorder."
    Did those who reacted to gluten suffer from gluten sensitivity? Is that why they still reacted negatively to gluten despite not carrying the gene for celiac? It would be interesting to find out.
    In my clinical experience, it is often the case that a patient suffers from IBS but does not have celiac disease. We find them to be gluten sensitive. The treatment of avoiding gluten is still the same, but these patients do not carry the celiac gene.
    It seems that while a gluten-free diet isn't the answer for 100% of IBS patients, it is definitely a component in enough people suffering from IBS that it would be a shame to not test for it. Do you agree?
    It seems to be a better course than recommending eating gluten and avoiding beans, while stating there is no cure. I'm sorry if my comments seem caustic, but it is upsetting to see such advice given that, in my opinion, does next to nothing to improve the lives of those who are suffering.
    If you have IBS or know of someone who does, do consider getting testing for celiac disease and gluten sensitivity. Remember that these tests aren't perfect. Even if you test negative, it would do no harm to try a 30 day gluten elimination diet.
    Let me know how it goes and please contact me should you have any questions. Our destination clinic treats patients from across the country and internationally, so you don't need to live locally to receive help. You can call us for a free health analysis at 408-733-0400.
    Reference:
    Gastroenterology. 2013 Jan 25. pii: S0016-5085(13)00135-2. doi: 10.1053/j.gastro.2013.01.049. A Controlled Trial of Gluten-Free Diet in Patients with Irritable Bowel Syndrome-Diarrhea: Effects on Bowel Frequency and Intestinal Function. Vazquez-Roque MI, Camilleri M, Smyrk T, Murray JA, Marietta E, O'Neill J, Carlson P, Lamsam J, Janzow D, Eckert D, Burton D, Zinsmeister AR.

    Jefferson Adams
    Celiac.com 05/26/2017 - Can a gluten-free diet help improve symptoms in people suffering from IBS? A new study says yes, some of them, at least.
    More than 60% of patients with IBS suffer from bloating and abdominal pain after eating certain foods. In some patients, who do not have celiac disease or wheat allergy, these symptoms may be due to an adverse reaction to wheat and gluten.
    Several studies have suggested that anti-gliadin antibodies can be a useful benchmark for predicting which patients with irritable bowel syndrome will benefit from a gluten-free diet. However, the idea remained untested until recently, when researchers conducted a prospective study in IBS patients.
    An update on their research was presented at Digestive Disease Week. The research was conducted by María Inés Pinto Sanchez, MD, and colleagues at the department of medicine at McMaster University and the Farncombe Institute in Ontario, Canada.
    To better understand the usefulness of these predictors, the research team looked at 44 patients with IBS and 23 healthy volunteers, both before and after 1 month of adhering to a gluten-free diet. They assessed GI transit, GI symptoms, anxiety, depression, somatization and dietary habits. The team tested each subject for anti-gliadin antibodies, then stratified the patients based on the results. Patients with celiac disease were not included in the study.
    The investigators found that just over half (53%) of the IBS patients, and 25% of the healthy volunteers, tested positive for IgA or IgC anti-gliadin antibodies. Additionally, HLA DQ2/DQ8 genetic predisposition was comparable for both groups.
    IBS patients who tested positive for antigliadin antibodies, and who followed a gluten-free diet, showed overall improvement in symptoms, especially constipation (P = 0.01), diarrhea (P = 0.001) and abdominal pain (P < 0.001) while IBS patients who tested negative only experienced improvements in abdominal pain (P = 0.01). Compared with patients who tested negative, gluten-free IBS patients who tested positive saw more normalization in GI transit (OR = 1.75 95% CI, 1.06 - 3.06).
    Regardless of antibody status, all IBS patients saw comparable improvements in anxiety, somatization and well-being, but only patients who tested positive saw reduced depression scores.
    A gluten-free diet in patients who tested positive for anti-gliadin antibodies was associated with symptomatic improvement (OR = 8.54; 95% CI, 1.41-48.21), while other factors like changes in motility, dietary adherence or genetic risk were not.
    Their data led the team to conclude that anti-gliadin antibodies can be used to determine which IBS patients are more likely to see an improvement in symptoms, and in functionality.
    Interestingly, strict compliance with the gluten-free diet did not predict improvement, which indicates that gluten restriction, rather than gluten avoidance, may help to manage symptoms in these IBS patients. That means that patients might be able to get better by cutting back on gluten, instead of cutting it out of their diet entirely.
    Read more at Healio.com.

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    Doritos does make a few gluten-free versions.     
    Just wanted to chime in. During my 2 plus years of healing I had joint pain and muscle pain with some of the nightshade mainly peppers and tomato. I stopped them. I can now eat them again. My theory is when my gut gets cc my holey gut dumps some of my food in my blood stream and my already ticked off immune system let's me know what is allowed. Apparently for a time nightshades  of potato, tomatos, and peppers were an issue. I was able to gradually introduce potatoes first and then tomatos, then
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