What's the Difference Between IBS and Celiac Disease?

Celiac.com 01/16/2023 - We get a lot of questions about celiac disease and related conditions. Recently, we've seen a lot of questions from people wondering about the difference between Irritable Bowel Syndrome (IBS), and celiac disease. We've done a number of articles on how the two conditions can sometimes have similar symptoms. How do you know which is which? What's the difference in symptoms, diagnosis, and treatment?

Celiac disease is an auto-immune condition in which wheat, rye, or barley triggers gut damage. Irritable bowel syndrome (IBS) is a complex gastrointestinal disorder that can cause a significant decrease in patient quality of life. Doctors and researchers still know very little about the origins or triggers for IBS.

IBS is More Common than Celiac Disease

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While celiac disease affects about one percent of the population, IBS affects 10 to 15 percent of the U.S. population. It is more common in women, but can affect individuals of both genders and all ages. 

IBS and Celiac Can Have Similar Symptoms

The cause of IBS remains poorly understood by medical professionals. Experts believe IBS symptoms may have more than one cause. IBS is often marked by numerous symptoms, including abdominal pain, constipation and diarrhea, or both constipation and diarrhea, as well as bloating, nausea and vomiting. The most common symptom associated with IBS is abdominal pain. 

Symptoms of celiac disease can include diarrhea, constipation, nausea, vomiting, stomach cramps, gas and bloating, or weight loss. Some people also have anemia, acid reflux or heartburn, itchy skin rashes or blisters, numb or tingly feet or hands, joint pain, headaches, mouth sores, or damage to tooth enamel. 

However, many IBS symptoms are also common in celiac disease. To make matters more confusing, numerous studies have shown that a high percentage of patients with IBS are also sensitive to gluten. Even though many of these symptoms can mimic celiac disease, most people with IBS typically do not have celiac disease.

In addition to celiac disease, a number of other diseases can mimic IBS, including inflammatory bowel disease, bacterial infections, colon cancer, and thyroid disease. These diseases typically show more severe symptoms, including rectal bleeding, weight loss and low blood counts, which are not normally seen in patients with IBS. However, IBS does not lead to an increased risk of cancer.

No Easy Way to Diagnose IBS

Whereas many conditions, like celiac disease, can be spotted by screening, examinations or testing, IBS is a disease that requires ruling out other contains for a diagnosis. Once other diseases and conditions are ruled out, IBS is often left as the only option standing, and so becomes the the accepted diagnosis.

Rule Out Other Diseases to Diagnose IBS

In order to diagnose IBS, other diseases, including celiac disease, must first be ruled out. That usually means a celiac disease blood screen, and possibly a colonoscopy or upper endoscopy. It also typically means screens and tests to rule out other conditions with similar symptoms.

Easy to Rule Out Celiac Disease

While some of the symptoms of IBS and celiac disease can be similar, it's usually fairly easy to test for celiac disease, and to rule it in or out based on screening results. Unlike people with celiac disease, most people with IBS do not suffer from damage to the intestinal villi. Most people with IBS will test negative for a celiac disease blood screen, and show no celiac-associated gut damage. Obviously, patients with celiac disease rarely also have IBS. So, if celiac disease is diagnosed, that's usually the end of the confusion. If celiac disease is ruled out, then the diagnostic journey can continue until other possible conditions and diseases are ruled out as well.

Treatment for IBS

Unlike celiac disease, where a gluten-free diet usually resolves symptoms and returns normal gut health, treatment of IBS is largely a matter of managing the symptoms. First treatment options should start with diet. If you suspect you have IBS, it's good to keep a food journal. Write down everything you eat and drink, and how you feel afterward. Try to eliminate any foods or drinks that seem to cause symptoms.

Gluten-Free Diet Helps Some IBS Patients

Many patients with IBS respond to a gluten-free diet. However, a gluten-free diet is typically not recommended for the treatment of IBS. That's because it usually won't resolve the symptoms on its own, and many people with IBS do seem to tolerate gluten with no issues.

Low FODMAP Diet Helps Some IBS Patients

One recent study shows that IBS patients on a low FODMAP diet show marked reduction in IBS symptom severity, along with reduced levels of fecal calprotein after the gut microbiota return to normal. If your doctor suspects IBS, it's best to consult a dietician or nutritionist before you embark on a gluten-free or a low-FODMAP diet.

Typically, foods that may trigger symptoms are slowly reintroduced into the diet after about six weeks. In addition to dietary measures, psychological interventions, such as counseling and exercise, have been shown to improve IBS symptoms.

Yogurt Can Help Resolve IBS Symptoms

A recent study shows that homemade yogurt resolves IBS symptoms in most patients.

Medicine Can Help Control IBS Symptoms

Unlike celiac disease, medicines, such as peppermint oil, fiber, minimally absorbed antibiotics, anti-nausea medications, anti-diarrheal medication, laxatives, anti-spasmodics and anti-depressants, can sometimes help improve IBS symptoms. Probiotics are not typically used to treat IBS, but might be an option based on your particular symptoms. Check with your doctor.

Exercise and Counseling Can Help IBS Patients

Regular gentle exercise, such as walking, yoga and swimming are helpful for IBS. Exercise helps to relieve stress, release anti-oxidants and endorphins, and improve gut health. Some research indicates that alternative therapy, including acupuncture, yoga, hypnosis, meditation, and physical therapy, may help to alleviate IBS symptoms. Counseling, especially cognitive behavioral therapy, can also help IBS patients to keep an eye on their GI symptoms.

No cure for IBS

Unlike celiac disease, in which gut damage usually reverses, and symptoms usually improve, on a gluten-free diet, IBS cannot be cured. But IBS can be managed to achieve minimal symptoms. Therapy for IBS must be tailored for each patient, usually in consultation with the physician, often by trial and error. 

There are many great resources available for IBS patients, including helpful websites, support groups, and phone apps to track symptoms and food intake.

Though IBS can be painful and confusing, many patients improve once they are diagnosed and begin to work actively to reduce symptoms and manage the condition. 

Read more at WebMD.com