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Found 17 results

  1. Celiac.com 08/05/2017 - I was told that I had irritable bowel disease about thirty years before being diagnosed with celiac disease. I avoided hard to digest foods such as corn, broccoli, beef and other foods difficult to digest, and instead I would, for instance, eat the bun of a hamburger, avoid steaks but eat the buttered buns and the gravy with a main meal and wondered why I was still having the gut and bowel reactions! Did you know that even in the absence of fully developed celiac disease, gluten can induce symptoms similar to FBD (Functional Bowel Disorder)? Doctors such as Elena F. Verdu, David Armstrong and Joseph Murray describe celiac disease and irritable bowel syndrome (IBS) as the "no man's land of gluten sensitivity.” Celiac disease is a condition traditionally characterized by chronic inflammation of the proximal small intestine resulting in villus atrophy and malabsorption. Irritable bowel disease is a clinical syndrome defined in the most recent Rome III consensus by the presence of abdominal pain or discomfort, at least three days per month in the last three months, and two or more other symptom features: 1) Improvement in defecation, 2) Association with a change in stool frequency, and 3) Association with a change in stool form or appearance. Other GI symptoms, such as bloating and distension are also considered to be consistent with a diagnosis of FBD (Functional Bowel Disorder) such as IBS. Did you know IBS has a prevalence of about 10% and is the most common GI disorder in our society, imposing a very high economic burden in North America? Did you know that there is an overlap between IBS and celiac disease? It has been reported that testing for celiac disease in patients with diarrhea-predominant IBS is cost effective if the prevalence of celiac disease is above 1%. Not only do the symptoms of IBS and celiac disease overlap, but epidemiological studies also suggest a greater than by chance association (4 - 5 fold increased risk). By convention, a patient with confirmed celiac disease is no longer considered to have IBS. It has never been determined whether celiac disease and IBS cannot co-exist, and there is no reason to think that a diagnosis of celiac disease necessarily precludes a diagnosis of IBS. Dr. Fasano has concluded that about 3% of patients with a "clinical" presentation of IBS were subsequently diagnosed with celiac disease. I would wager that many of you with confirmed celiac disease may also have the symptoms of irritable bowel disease. I cannot be alone in this! I can check off the symptoms of IBS on many occasions and yet I have diagnosed celiac disease and dermatitis herpetiformis. In Dr. Fasano's report: "they have concluded that gluten induced Patho-physiology may constitute an underlying factor in symptom generation in a proportion of patients with IBS like symptoms." A lot of this wording may seem like Greek or a "little over ones head" so to speak, but I believe what they are saying is though we define gluten sensitivity as a condition of some morphological, immunological, or functional disorder that responds to gluten exclusion and NOT a true disease. Gluten sensitivity changes that occur with IBS because of exposure to gluten are eventually going to show up positive for celiac disease. Why would a person who has been diagnosed and KNOWS that they have irritable bowel disease continue to ingest gluten when Fasano et. al., have concluded that about 3% of patients with a "clinical" presentation of IBS were subsequently diagnosed with celiac disease? Did you know that in July of 2016 teams of researchers at Columbia University published a study confirming that wheat exposure response is, in fact triggering a systemic immune reaction and accompanying intestinal cell damage. "It is estimated that the impacted population is equal to or even exceeds the number of individuals with celiac disease, the vast majority of whom remain undiagnosed" Dr. Armin Alaedin confirmed. Finally they are reporting that a person with irritable bowel disease may have gotten that way from ingesting gluten. Celiac Disease and Dermatitis Herpetiformis – Did You Know? 15 - 25% of individuals with celiac disease experience dermatitis herpetiformis? Dermatitis herpetiformis is a skin manifestation of celiac disease and is part of the abnormal immune response to gluten; Affects more men than women? Dermatitis herpetiformis generally starts in adulthood. It is not common to see dermatitis herpetiformis in children, but it can occur; Only about 20 percent of people with dermatitis herpetiformis have intestinal symptoms of celiac disease, however, biopsies show that 80 percent have some degree of damage to the small intestine, especially if a high gluten diet is maintained; If you suspect dermatitis herpetiformis you may have celiac disease; Iodine is something that a person with dermatitis herpetiformis should definitely avoid; One of the oldest checks for dermatitis herpetiformis was putting some iodine on ones thigh; Dermatitis herpetiformis sores tend to run in a line, or stay in a cluster; Dermatitis herpetiformis treatment consists of a gluten-free diet for life, just like in celiac disease? The skin's response to the gluten-free diet is much slower compared to the healing of the intestines in those with celiac disease. It may take about six months to achieve improvement, though with my own dermatitis herpetiformis spots daily dapsone was miraculous. It did take up to a year for the sores in my scalp to heal. Dr. John Zone, M.D. Professor and Dermatology Chair at the University of Utah and CDF Medical Advisory Board member states "There is little question that ingestion of large amounts of iodine dramatically worsens dermatitis herpetiformis," he continues, "iodine does not cause dermatitis herpetiformis. It worsens dermatitis herpetiformis. Gluten causes dermatitis herpetiformis." Dr. Zone explains that through seeing hundreds of celiac disease patients over the years, he has found that some react to highly concentrated solutions of iodine in cough medicines, shellfish, and kelp, which is often found in Sushi. He also cautions that dietary supplements may contain large amounts of kelp or iodine (usually in the form of potassium iodide or sodium iodide) which can worsen dermatitis herpetiformis. I can share with you that I was incorrectly told over 25 years ago by an internist that I could take up to five dapsone, going 5- 4 - 3- 2 -1, and if the spots had not totally disappeared I could repeat the process. Taking too much cased a blood disorder called Methemaglobinemia, a rare but dangerous response to taking too much dapsone. It is a blood disorder in which an abnormal amount of methemoglobin is produced. Hemoglobin is the protein in red blood cells (RBCH's) that carries and distributes oxygen to the body. Methemoglobin is a form of hemoglobin, with it the hemoglobin can carry oxygen, but is not able to release it effectively to body tissues. It can either be passed down through families (inherited or congenital) or be caused by exposure to certain drugs, chemicals, or foods (acquired). My nephew was on dapsone, which is, according to the Head of Dermatology at the University of British Columbia, the true test of dermatitis herpetiformis. By taking Dapsone for three or four days the lesions (itchy/sore blisters that beg to be itched, and when you do you break open a lesion that appears to contain liquid...they burn, then they crust, and if you continue to pick off that crust they scar your skin.) almost disappear like magic. My nephew thought it was permissible to cheat once in a while and thought that he could get away with it. He used to eat hamburgers every time the craving for a "Big Mac" overcame him! He ate one, or maybe two, until he found out he had dermatitis herpetiformis sores on the soles of his feet and was limping from the pain. Who knows what damage he was doing to the villi in his bowel! It is a vast no man's land out there, but if you are a celiac and have dermatitis herpetiformis or are gluten sensitive you need to step into that “land” and learn more about the diseases and what is going on in your body!
  2. Celiac.com 09/23/2015 - Wheat products are a key component of human diets worldwide. Despite the many beneficial aspects of consuming wheat products, it is also a trigger for several diseases such as celiac disease, wheat allergy, and non-celiac gluten sensitivity (NCGS). A team of researchers recently set out to examine the relationship between celiac disease, non-celiac gluten sensitivity and irritable bowel syndrome. The research team included M El-Salhy, JG Hatlebakk, OH Gilja, and T. Hausken. They are variously affiliated with the Section for Gastroenterology, Department of Medicine, Stord Hospital, Stord, Norway, the Section for Neuroendocrine Gastroenterology, Division of Gastroenterology, Department of Clinical Medicine, University of Bergen, Bergen, Norway, the National Centre for Functional Gastrointestinal Disorders, Department of Medicine, and the National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway. Celiac disease and irritable bowel syndrome (IBS) patients have similar gastrointestinal symptoms, which can result in celiac disease patients being misdiagnosed as having IBS. Therefore, celiac disease should be excluded in IBS patients. A considerable proportion of celiac disease patients suffer from IBS symptoms despite adherence to a gluten-free diet (GFD). The inflammation caused by gluten intake may not completely subside in some celiac disease patients. It is not clear that gluten triggers symptoms in NCGS, but there is compelling evidence that carbohydrates in wheat such as fructans and galactans do. Based on their results, the team feels that it is likely that NCGS patients are a group of self-diagnosed IBS patients who self-treat using a gluten-free diet. Source: Nutr J. 2015 Sep 7;14(1):92. doi: 10.1186/s12937-015-0080-6.
  3. 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. For their double-blind randomized, placebo-controlled trial, the team enrolled 148 IBS patients who fulfilled Rome III criteria between 2011 and 2013. 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.
  4. Celiac.com 05/14/2012 - Should gluten sensitivity be thought of as “celiac light,” as just one of the milder manifestations within the wider spectrum of celiac disease? Some doctors and researchers think so. Over the past several years, there has been increasing discussion concerning gluten sensitivity as a possible cause of irritable bowel syndrome (IBS) symptoms in patients for whom celiac disease has been excluded. This is undoubtedly because gluten sensitivity, like IBS, is a symptom-based condition of diverse pathogenesis. As discussed, some have argued that gluten sensitivity might be best thought of as “celiac light,” representing the milder domains of the celiac disease spectrum. However, there are some data to suggest that a subset of patients with gluten sensitivity may actually belong to the spectrum of celiac disease. In a recent letter to the editors of the American Journal of Gastroenterology, doctors Courtney C. Ferch and William D. Chey of the Division of Gastroenterology at the University of Michigan Health System in Ann Arbor, Michigan, comment at length on the latest findings regarding Irritable Bowel Syndrome and gluten sensitivity without celiac disease. Ferch and Chey note that gluten sensitivity is one of the most rapidly growing sectors in the food industry, with gluten-free products accounting for $1.31 billion in U.S. sales alone in 2011. Those sales are expected to exceed $1.6 billion by 2015. Major food manufacturers such as General Mills and Betty Crocker, along with popular restaurant chains like PF Chang's and Subway are busy introducing new gluten-free options, or retooling original products into gluten-free versions. People with gluten sensitivity typically show symptoms after eating gluten, but show no evidence of celiac disease or food allergy. Unlike celiac disease, there are no accepted biomarkers for gluten-sensitivity. Doctors diagnose the condition mainly by looking at the connection between eating gluten and the presence adverse symptoms. Numerous studies on gluten sensitivity suffer have included small sample size, a lack of adequate controls, a lack of blinding, and the use of non-validated outcome measures. Even with these limitations, Ferch and Chey say there are several studies worthy of further consideration. One of the studies discussed in the Ferch and Chey was a double-blind, placebo-controlled, dietary re-challenge trial performed by Biesiekierski et al. The study sought to better understand the role of gluten ingestion in the development of gastrointestinal (GI) and non-GI symptoms in patients diagnosed with IBS. The Biesiekierski study included a sample of 34 patients diagnosed with IBS by the Rome III criteria who had experienced symptom improvement with a gluten-free diet for 6 weeks before study enrollment. Celiac disease had been excluded in all study participants by either a negative HLADQ2/HLA-DQ8 haplotype or a normal duodenal biopsy. The study excluded patients with conditions such as cirrhosis, inflammatory bowel disease, non-steroidal anti-inflammatory drug ingestion, or excessive alcohol. Over a six week double-blind randomization phase, study participants followed either a gluten-free or gluten-containing diet that was assigned at random. Nineteen of the 34 patients ate food containing 16 g of gluten per day. The other 15 patients ate gluten-free bread and mufï¬ns. Gluten used in the study was free of fermentable oligo-, di-, monosaccharides and polyols, and its protein distribution included 2.3% nongluten, 45.7% glutenin, and 52% gliadin. The primary outcome of the study was the proportion of patients answering “no” on over half of the occasions at the end of each week to this question: “Over the past week, were your symptoms adequately controlled?” The study team also assessed secondary outcomes including bloating, abdominal pain, satisfaction with stool consistency, nausea, and tiredness using a 100-mm visual analog scale. Once the study period ended, the results showed that many more patients in the gluten group compared with the gluten-free group answered “no” to the primary outcome question (68% vs 40%; P .001). Compared with the gluten-ingesting group, those who remained gluten-free also reported signiï¬cant improvements in pain (P .016), bloating (P .031), satisfaction with stool consistency (P .024), and tiredness (P .001), although they showed similar levels of wind (P .053) or nausea (P .69). The results of celiac antibodies at baseline and after the dietary intervention were similar. The team also found that diet had no effect on intestinal permeability as measured by urine lactuloseto-rhamnose ratio. Additionally, they found detectable fecal lactoferrin levels in just one patient during the treatment period. Meanwhile, high-sensitivity C-reactive protein levels remained normal before and after the dietary intervention. There was no difference in the level of symptoms experienced by those with and without HLA-DQ2 and HLA-DQ8 alleles. The authors felt that these data support the existence of non–celiac-associated gluten sensitivity. They concluded that gluten is in fact tied to overall IBS symptoms, bloating, dissatisfaction with stool consistency, abdominal pain, and fatigue in some patients. In their letter, Ferch and Chey also comment on several side issues. First, they note that a recent global meta-analyses of studies showed that patients with IBS symptoms had signiï¬cantly higher rates of celiac disease than controls. As such, they point out that the American College of Gastroenterology Task Force now recommends routine celiac blood screens for patients with diarrhea-predominant IBS and IBS with a mixed bowel pattern (grade 1B recommendation). Secondly, they note that there has been much recent discussion around the potential role of food in IBS symptoms that has focused on celiac disease. However, they point out that much has been made over the possible role of food, and possibly celiac disease, in IBS symptoms. However, they note that data from US studies show no higher risk for celiac disease among patients with IBS symptoms and no warning signs. Although these results are certainly intriguing and hypothesis generating, they require validation in larger, randomized, controlled trials in other parts of the world. What is clear and important for providers to understand is that gluten sensitivity is here to stay and signiï¬cantly more likely for them to encounter in day-to-day practice than celiac disease. Read the full letter by Ferch and Chey at the website for the American Journal of Gastroenterology. Source: Am J Gastroenterol 2011;106:508 –514
  5. Celiac.com 06/14/2013 - A team of researchers recently conducted a controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea to gauge the effects on bowel frequency and intestinal function. Their goal was to determine whether a gluten-free diet might benefit patients with diarrhea-predominant irritable bowel syndrome (IBS-D). The team included M.I. Vazquez-Roque, M. Camilleri, T. Smyrk, J.A. Murray, E. Marietta, J. O'Neill, P. Carlson, J. Lamsam, D. Janzow, D. Eckert, D. Burton, A.R. Zinsmeister. They are variously affiliated with the Clinical Enteric Neuroscience Translational and Epidemiological Research at the Mayo Clinic in Rochester, Minnesota, and the Division of Gastroenterology and Hepatology at the Mayo Clinic in Jacksonville, Florida. The team designed a randomized controlled 4-week trial comparing the effects of a gluten-containing diet against gluten-free diet in 45 patients with IBS-D. They conducted genotype analysis for HLA-DQ2 and HLA-DQ8, and randomly placed twenty-two patients on the gluten-containing diet (11 HLA-DQ2/8 negative and 11 HLA-DQ2/8 positive) and 23 patients on the gluten-free diet (12 HLA-DQ2/8 negative and 11 HLA-DQ2/8 positive). They measured daily bowel function, small-bowel and colonic transit. They used lactulose and mannitol excretion to measure mucosal permeability, and peripheral blood mononuclear cells after exposure to gluten and rice to gauge cytokine production. The team collected rectosigmoid biopsy specimens from 28 patients, analyzed levels of messenger RNAs encoding tight junction proteins, and performed H&E staining and immunohistochemical analyses. They analyzed covariance models to compare data from the gluten-containing and gluten-free diet groups. They found that subjects on the gluten-containing diet had more bowel movements per day (P = .04); the gluten-containing diet had a greater effect on bowel movements per day of HLA-DQ2/8-positive than HLA-DQ2/8-negative patients (P = .019). They also found that the gluten-containing diet was associated with higher SB permeability, based on 0-2 h levels of mannitol and the ratio of lactulose to mannitol. They found that SB permeability to be greater in HLA-DQ2/8-positive than HLA-DQ2/8-negative patients (P = .018), and saw no significant differences in colonic permeability. Patients on the gluten-containing diet had a small decrease in expression of zonula occludens 1 in SB mucosa and significant decreases in expression of zonula occludens 1, claudin-1, and occludin in rectosigmoid mucosa. The effects of the gluten-containing diet on expression were substantially greater in HLA-DQ2/8-positive patients. Neither diet had any significant effects on transit or histology. Peripheral blood mononuclear cells produced higher levels of interleukin-10, granulocyte colony-stimulating factor, and transforming growth factor-α in response to gluten than rice, regardless of HLA genotype. The team's findings show that gluten alters bowel barrier functions in patients with IBS-D, especially in HLA-DQ2/8-positive patients, and that these aspects of IBS can be reversed with a gluten-free diet. Source: Gastroenterology. 2013 May;144(5):903-911.e3. doi: 10.1053/j.gastro.2013.01.049. Epub 2013 Jan 25.
  6. Celiac.com 02/25/2013 - Patients with celiac disease often report symptoms compatible with irritable bowel syndrome (IBS). However, there haven't been any systematic studies regarding how adherence to a gluten-free diet might affect rates of irritable bowel syndrome-type symptoms in patients with celiac disease. To better answer that question, a research team conducted a meta-analysis of celiac disease patients to determine rates of irritable bowel syndrome-type symptoms, and how those symptoms relate to a gluten-free diet. The research team included A. Sainsbury, D.S. Sanders, and A.C. Ford, of the Leeds Gastroenterology Institute at St James's University Hospital in Leeds, United Kingdom. For their analysis, the team searched MEDLINE, EMBASE, and EMBASE Classic to identify cross-sectional surveys or case-control studies reporting prevalence of IBS-type symptoms in adult patients (≥16 years old) with established celiac disease. The team used case or control status and adherence to a gluten-free diet to determine the number of individuals with IBS symptoms. The team analyzed data from 7 studies with 3383 participants. They then calculated pooled prevalence and odds ratios (ORs), with 95% confidence intervals (CIs). They found that pooled prevalence of IBS-type symptoms in all patients with celiac disease was 38.0% (95% CI, 27.0%-50.0%). People with celiac disease had higher pooled odds ratios for IBS-type symptoms than did control subjects (5.60; 95% CI, 3.23-9.70). In patients who did not follow a strict gluten-free diet, the pooled odds ratios for IBS-type symptoms, compared with those who were strictly adherent, was 2.69 (95% CI, 0.75-9.56). Patients who did not adhere to the gluten-free diet had higher odds ratios for IBS-type symptoms compared with controls (12.42; 95% CI, 6.84-11.75). Such patients also had higher odds ratios compared with that observed for celiac disease patients who followed a strict gluten-free diet or controls (4.28; 95% CI, 1.56-11.75). The results show that patients with celiac disease suffer IBS-type symptoms more frequently than control subjects, and that following a strict gluten-free diet might help to reduce those symptoms. Source: Clin Gastroenterol Hepatol. 2012 Dec 13. pii: S1542-3565(12)01491-7. doi: 10.1016/j.cgh.2012.11.033.
  7. Celiac.com 05/18/2011 - Irritable Bowel Syndrome (IBS) is based on a clinical description only; there are no pathophysiological pathways definitively associated with it. It is characterized as gastrointestinal symptoms with no discernable cause. A diagnosis of IBS depends on recurrent abdominal pain or discomfort for at least three days per month in the last three months, with the onset of the discomfort either associated with a change in frequency or appearance of stool or alleviated by defecation. A number of different mechanisms have been suggested as potential causes of IBS. These range from psychological origins, to increased visceral hyperalgesia (sensitivity to pain), to the low grade gut inflammation and altered gastrointestinal permeability and motility observed in IBS patients. Complicating matters is that most patients exhibit only a subset of symptoms. Since gluten has been demonstrated to negatively affect even people without celiac disease by an unknown mechanism (see Study Shows Gluten Intolerance Without Celiac Disease), and the underlying causes of IBS remain unclear, Dr. Elena Verdu wondered if gluten might contribute to IBS. Like those with IBS, patients with gluten sensitivity lack the antibodies against tissue transglutaminase that are the hallmark of celiac disease but nonetheless suffer immune mediated inflammation in their gut. Interestingly, when IBS patients without celiac eliminated gluten from their diet, 68% of them reported more severe pain, bloating, and tiredness upon gluten rechallenge. But how – by what mechanism? No changes were detected in intestinal permeability or fecal lactoferrin, a marker of intestinal inflammation. However, it is possible that these phenomena persisted, just at below the level of detection. Based on these data, and other evidence that is rapidly accruing suggesting that gluten can negatively affect those without celiac disease, Dr. Verdu suggests that IBS patients might be screened for anti-gliadin antibodies even if they lack antibodies against tissue transglutaminase. These nonspecific antibodies can indicate an immunological response to gluten, and thus their presence could used to determine if their symptoms might be alleviated by adherence to a gluten free diet. She makes sure to point out, though, that this is probably not the case for all IBS patients. Source: Am J Gastroenterol 2011; 106:516–518
  8. Celiac.com 10/09/2009 - The causes and mechanisms that fuel the development of gastrointestinal symptoms, along with the individual perceptions of those symptoms are varied and, in many cases, not well understood. A team of researchers recently set out to explore the clinical and experimental evidence regarding the possible association between gluten sensitivity, celiac disease, irritable bowel syndrome, and the development of gastrointestinal symptoms. The research team was made up of Elena F. Verdu, MD, PhD, David Armstrong, MA, MB, BChir, and Joseph A. Murray, MD. The team's hypothesis is that, even in the absence of fully developed celiac disease, gluten exposure can trigger symptoms that mirror FBD. To test that hypothesis, the team set out to see how many people with gluten sensitivity are likely to suffer from symptoms similar to functional bowel disorder (FBD). The team proposes model for the exploring and assessing factors influencing the development of gastrointestinal symptoms and dysfunction by gluten in FBD and organic disease. They elaborate on their hypothesis that gluten sensitivity and post-infectious irritable bowel syndrome (IBS) represent two triggers that can explain at least part of the wide range of IBS symptoms and dysfunction. Better understanding this relationship offers researchers a better understanding of the role of mucosal responses to luminal factors in FBDs. The team proposes that the animal model of gluten sensitivity in human leukocyte antigen (HLA)- DQ8 mice permits exploration of mucosal pathophysiological changes that develop before the onset of advanced inflammation in gluten sensitive individuals. A clearer picture of the means by which gluten triggers symptoms in sensitive individuals will help to shed light on the interactions between host genotype, diet, and intestinal microbiota in triggering gluten sensitivity. The goal of the review is to shed light on the connections between celiac disease, IBS, and gluten sensitivity, as well as to emphasize several important facts. First, 'gluten sensitivity' is marked by one or more various immunological, morphological, or symptomatic problems that may also be common to celiac disease and IBS. Second, gluten sensitivity and classic celiac disease may have common roots, but people with gluten sensitivity do not meet the clinical threshold for celiac disease. Third, while gluten sensitivity and IBS may share common symptomatology, gluten sensitivity by definition is not IBS. Successful treatments for IBS have are few, due to the lack of pharmacological targets and even a conceptualized framework for the basic pathogenetic mechanisms. In some patients with symptoms of post-infectious IBS, doctors have been able to associate the role of subtle persistent inflammation in as a likely trigger for gut immune responses. They conclude that recent clinical evidence supports the view of gluten sensitivity as the likely cause of gastrointestinal symptoms that would otherwise point to of IBS. This information dovetails with other recent information regarding the prevalence of gluten sensitivity. The idea that gluten sensitivity is far more widespread than believed , and that gluten sensitivity lies at the heart of numerous gastrointestinal and other systemic disorders is rapidly gaining support from data, and drawing new believers within the scientific community. Source: Am J Gastroenterol 19 May 2009; doi: 10.1038/ajg.2009.188
  9. Celiac.com 03/04/2011 - Celiac disease is similar to the inflammatory bowel diseases, ulcerative colitis and Crohn’s disease, in the obvious sense that all are chronic inflammatory disorders of the gastrointestinal tract. But more than that, they all also present daily psychological and social challenges to patients’ lifestyles. In a recent study reported in the European Journal of Gastroenterology and Hepatology, researchers in the United Kingdom examined the prevalence of GI symptoms in patients with these diseases and correlated the incidence of these symptoms with quality of life (QoL). Not surprisingly, they found that increased severity of reflux and irritable bowel syndrome were associated with a diminished QoL. Patients with celiac disease had worse symptoms and QoL than those with ulcerative colitis, but they were better off than people with Crohn’s disease. This cross-sectional study was performed by sending patients surveys through the mail. One thousand and thirty-one people were included; 225 patients with celiac, 228 with ulcerative colitis, 230 with Crohn’s disease, and 348 healthy age- and sex-matched controls. As this was a postal survey, there is a potential inclusion bias – it is possible that those patients faring the worst would be most likely to send back the questionnaires. Seventy one percent of the celiac patients reported adhering to a gluten-free diet, but this was not corroborated endoscopically. One of the surveys assessed physical and mental QoL and another considered depression and anxiety. Participants were also asked to report and rate GI symptoms they had experienced over the past month, including reflux, heartburn, regurgitation, belching, dysphagia (difficulty swallowing), and retrosternal pain. Barrat et al. found that the celiac patients had higher rates of belching and dysphagia than inflammatory bowel diseases sufferers in this study and also than reported previously. They highlight that despite the high (71%) degree of adherence to the gluten-free diet, 22% of celiac patients still reported severe enough IBS symptoms to affect their QoL. They infer from this finding a couple of noteworthy things. First, that the gluten-free diet may not adequately control IBS symptoms in celiac patients. But also, that doctors are perhaps not inquiring about reflux and IBS during consultations, or patients are under-reporting their prevalence. The authors thus suggest that QoL might be improved for these patients if doctors were more diligent in assessing them for reflux and irritable bowel syndrome. Source: European Journal of Gastroenterology & Hepatology: February 2011 - Volume 23 - Issue 2 - p 159–165
  10. Celiac.com 05/28/2010 - Celiac disease research is linking Irritable Bowel Syndrome with gluten intolerance and doctors are recommending IBS sufferers, especially those with diarrhea-predominant IBS, to get tested for gluten issues or celiac disease. Celiac disease is an autoimmune disease. The source of this being gluten, a protein found in wheat, barley, and rye, often affecting the entire body and manifesting various physical and mental symptoms, and a gluten-free diet is the simple treatment for this disease. New research published in the Archives of Internal Medicine has shown that people with IBS are four times more likely to have celiac disease than those without IBS. Doctors, often uneducated about celiac disease or improperly taught that its symptoms are dramatic, don’t associate the common symptoms of IBS, stomachaches, bloating, fatigue, and diarrhea, with celiac disease or gluten intolerance. In the January 2009 issue of the American Journal of Gastroenterology, the American College of Gastroenterology began recommending that doctors screen patients who manifest symptoms of IBS for celiac disease as well. The diagnosis is easy to test for. Simple blood tests detect the disease over ninety percent of the time. The diagnosis is then confirmed by an upper endoscopy. A small, flexible tube is slipped into the mouth of the sedated patient, down his esophagus and stomach and into the first part of the small intestine, where biopsies are taken and then examined for changes seen in celiac disease. After a correct diagnosis is made, people with IBS who are also celiac can begin the rapid road to recovery with a gluten-free diet. As people become more aware of celiac disease and gluten intolerance, gluten-free foods and gluten-free cooking become more and more available. There are now many delicious gluten-free recipes available for favorite foods and desserts such as gluten-free pizza, gluten-free muffins, and gluten-free cupcakes. Adults and children alike who are gluten intolerant can still enjoy a gluten-free balanced diet with a variety of gluten-free choices. In the U.S., a slightly increased rate of celiac diagnosis among adults has already lead to increased support. Gluten-free foods and gluten-free recipes are more readily available than ever. The Gluten-Free Restaurant Awareness Program (GFRAP) assists in the mutually beneficial relationship between people diagnosed with celiac disease or gluten intolerance and restaurants, resulting in an increase in the number of restaurants which can provide service to people following a gluten-free diet while increasing their patronage. Participating restaurants are able to provide gluten-free meals. As more and more people are diagnosed with gluten intolerance, their list of participating restaurants will surely grow. However, the U.S. remains behind in celiac awareness. This probably has something to do with the fact that celiac disease is the only autoimmune disease that the government doesn’t support with research grants. Centers such as Dr. Green’s Celiac Disease Research Center are one-hundred percent dependent on charitable donations or university funds. Even though diagnosis is slightly up for celiac adults, this isn’t enough to raise awareness and bring relief for the three million people who suffer from celiac disease, nearly ninety-seven percent of whom don’t even know the cause of their painful symptoms. With increased diagnosis, we will surely see increased support, and soon the celiac community will be able to enjoy the same quality of life and food and cooking options which is enjoyed by, for instance, the lactose-intolerant community. If you have been diagnosed with IBS or have similar symptoms, make an appointment with your doctor today to get tested for celiac disease or gluten intolerance. It may just bring you the relief you’ve been looking for all these years.
  11. Celiac.com 05/06/2008 - In the majority of people with celiac disease,strict adherence to a gluten-free diet can result in a quality of lifethat is on par with non-celiacs. Still a small percentage of celiacsseem to suffer from persistent gastrological discomfort in the form ofirritable bowel or irritable-bowel-like symptoms. Very few studies havebeen done on persistent gastrological problems in adults with celiacdisease. Those that have been done rely upon univariate statisticalanalysis in clinical samples at the secondary or tertiary care leveland fail to assess the potential influence of non-celiac diseasespecific factors, which are considered to be a risk factor of irritablebowel syndrome (IBS), such as mental disorders, or gender. Ateam of researchers made up of doctors Winfried Hauser, Frauke Musial,Wolfgang Caspary, Jurgen Stein, and Andreas Stallmach set out todetermine rates of irritable bowel syndrome, irritable bowelsyndrome-related symptoms, and consecutive health care-seeking behaviorand their influence upon health-related quality of life (HRQL) and anyconceivable bio-psychosocial factors influencing adult patients withceliac disease. The research team made a medical and socio-demographicsurvey of 1000 adult celiac patients from the German Celiac Society bypost. The medical portion of the survey included bowel history. Theteam also had patients fill out a Short Form Health Survey (SFHS),along with the Hospital Anxiety and Depression Scale. 516 ofthe questionnaires came back completed. Respondents were similar ingender ratio and median age from the whole membership directory of theGerman Celiac Society, a group of more than 18,000 people who reportedsuffering from celiac disease at the age of 18. Of these, 213 (41.3%)had a diagnosis of celiac disease that was made by a duodenal biopsy,37 (7.2%) by serological tests (celiac disease-specific antibodies), 34(6.6%) using stool tests for trans-glutaminase antibodies, and 232(45.0%) using intestinal biopsy and serological tests. A totalof 446 patients indicated that they had biopsy-proven celiac disease. Of these 446patients, 18 were excluded because they indicated adherence to agluten-free diet for less than 1 year. Sixteen patients were tossed outbecause they reported a major non-adherence to the gluten-free diet. Thus,the study group was confined to 412 patients with self-reportedbiopsy-proven celiac disease who were on a strict gluten-free diet for at least one year. The survey showed that out of these 412 patients that met the criteria, 96 patients, or just over 23% metmodified Rome I criteria for Irritable Bowel Syndrome. Of those 96patients, 76 patients, or nearly 80%, made an effort to get help, bothmedical and non-medical, as a result of the bowel symptoms (we’ll callthe patients who sought help "irritable bowel syndrome patients"). Irritable bowel syndrome-like symptoms were shown to drive SFHS scores sharply downward. Mentalhealth disorders, being female, falling off the gluten-free dietall contributed to a greater likelihood of irritable bowel syndrome symptoms. Theresults of the study seem strengthen the bio-psychosocial model of irritable bowel syndrome, in which biological and psychological factorsare understood to affect the clinical manifestation of celiac disease.Under this model, irritable bowel syndrome-like symptoms in adults withceliac disease are understood through a combination of clinical andsocio-psychological mechanisms. This model leads doctors to anunderstanding of celiac disease and other gastro-intestinal ailmentsthat goes beyond simple biological or psychological factors alone, andlooks at factors like adverse life events, stress, and hypochondriasisamong others. Limited studies indicate that gender differencesin visceral perception, cardio-autonomic responses, gastrointestinalmotility, and brain activation patterns to visceral stimuli are afactor in irritable bowel syndrome. Gender differences in psychosocialfactors have not been fully studied. The results of this studyalso support the need for further investigation to determine exactly whatfactors contribute to the bio-psychosocial model of what is called’celiac irritable bowel syndrome.’ Future psycho-physiologicalstudies in patients with celiac disease and irritable bowel syndromeshould look to determine if psychological discomfort can prolongmucosal inflammation, reduce visceral pain thresholds, or disturb gutmotility. In the event that the right psychotherapeutictreatment for irritable bowel syndrome-like symptoms and/or mentaldisorder serve to improve reduced HRQOL in adult patients with celiacdisease and irritable bowel syndrome-like symptoms, it might benecessary to take a second look at interventional practices. So,in a nutshell, this all means that things like mental health, gender,and other non-clinical factors might play a role in irritable bowelsyndrome-like symptoms in people with celiac disease, and that furtherstudy is needed to sort out all of the possibilities and determine ifthere might be better ways to treat celiac disease that will reduce oreliminate irritable bowel syndrome-like symptoms. Psychosomatic Medicine 69:370 –376 (2007)
  12. Celiac.com 05/18/2009 - People with clinical irritable bowel syndrome (IBS) suffer from biopsy-proven celiac disease at rates that are more than four times higher than in non-IBS control subjects, according to the results of a recent systematic review and meta-analysis conducted by Alexander C. Ford, MBChB, MD, MRCP, from Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada, and colleagues. Prior studies have indicated that people with IBS had higher rates of celiac disease, but evidence has not been clear, and medical guidelines do not always call for celiac screening in these individuals. To determine rates of celiac disease in random adults meeting clinical criteria for IBS, the research team reviewed MEDLINE from 1950 to May 31, 2008, and EMBASE from 1980 to May 31, 2008. They isolated case series and case-control studies that contained data for celiac disease blood screens. They found 14 such studies. From each study, they isolated and aggregated positive serologic test results for celiac disease and biopsy-proved celiac disease. They then compared the data to that for patients with IBS and control individuals, using an odds ratio (OR) and 95% confidence interval (CI). The team isolated 4204 suitable cases from the identified studies. Of those, 2278 met clinical criteria for IBS (54%). The overall rate of positive immunoglobulin A (IgA)–class antigliadin antibodies (AGA) was 4.0% (95% CI, 1.7% – 7.2%), the rate of positive endomysial antibodies (EMA) was 1.63% (95% CI, 0.7% – 3.0%), and the rate of tissue transglutaminase (tTGA) was 4.1% (95% CI, 1.9% – 7.0%). For biopsy-proven celiac disease, the overall rate was 4.1% (95% CI, 1.9% – 7.0%). In patients who met the clinical criteria for IBS compared with non-IBS control subjects, aggregate OR for positive IgA-class antigliadin antibodies was 3.40 (95% CI, 1.62 – 7.13), aggregate OR for either positive EMA or tTGA was 2.94 (95% CI, 1.36 – 6.35), and aggregate OR for biopsy-proved celiac disease was 4.34 (95% CI, 1.78 – 10.6). The study did have some weaknesses, including issues with the methodology governing study selection, possible spectrum bias in case-control studies, possible selection bias in studies based in secondary care, and, in some cases, results too limited to allow meaningful aggregation of data. Still the research team concludes that rates of biopsy-proven celiac disease are more than four times higher for IBS patients than for non-IBS controls. The team recommends that, if screening is undertaken, EMA or tTGA testing be used in lieu of IgA-AGA testing due to their higher positive predictive value, though they admitted that results will depend on celiac rates in the population being screened. The study was supported by the American College of Gastroenterology. Arch Intern Med. 2009;169:651–658.
  13. Aliment Pharmacol Ther 19(11):1199-1210, 2004. Celiac.com 06/08/2004 - Researchers at the University of California, San Francisco have determined that everyone with Irritable Bowel Syndrome (IBS) should also be screened for celiac disease. The researchers used decision analysis to estimate the number of celiac disease cases detected, quality-adjusted life-years gained, and costs resulting from screening suspected IBS patients for tissue transglutaminase antibody and antibody panel. Positive tests were followed up with an endoscopic biopsy. A gluten-free diet was initiated to improve the quality of life in those with celiac disease. The results of this study indicate that 3% of the 1,000 patients with suspected IBS have celiac disease. Based on these results the researchers analyzed the costs of several celiac disease screening methods used a decision analysis formula to determine whether or not the screening is cost effective. The researchers conclude that celiac disease screening in patients with suspected irritable bowel syndrome is likely to be cost-effective even at a relatively low celiac disease prevalence. Perhaps the researchers should have taken their analysis one step further and concluded that it would make good economic sense to screen the entire population of the USA (as well as that of other countries) for celiac disease, rather than just those with IBS, given the fact that it affects approximately 1% of the population--which is the only conclusion that I could reach after my review of their good work. -Scott Adams
  14. Celiac.com 06/15/2008 - Many people with celiac disease have stories to tell about the about how difficult it can be to get a getting a proper diagnosis. Celiac disease can mimic so many other conditions. Irritable Bowel Syndrome (IBS) is one of those conditions. The symptoms for Irritable Bowel Syndrome and for celiac disease are often similar as a result the diagnosis of celiac disease can be delayed or missed and misdiagnosed as irritable bowel syndrome. In an effort to reduce the misdiagnosis of celiac disease as Irritable Bowel Syndrome, Britain’s National Institute for Health and Clinical Excellence has drawn up new guidelines covering the diagnosis of Irritable Bowel Syndrome. The guidelines call for all diagnosis of Irritable Bowel Syndrome to be preceded by a screen for celiac disease. Keeping this in mind, anyone suffering from Irritable Bowel Syndrome, and who has not been tested for celiac disease, might want to take the initiative and check with their doctor to see if further testing might be in order. Studies show that a minimum of 1 out of every 100 people in Britain suffers from celiac disease, but that only 1 out of 8 is properly diagnosed. More worrisome still is the fact that new research shows that it takes an incredible 13 years on average before the diagnosis are made. That means 13 years of unnecessary pain and discomfort, to say nothing of potential systemic damage for those awaiting a proper diagnosis of celiac disease, including osteoporosis, bowel cancer and increased risk of other autoimmune diseases. Since similar numbers likely prevail in America, it's good to keep an eye on clinical changes like the one recently made in Britain. Again, for people diagnosed with IBS, but who have not been evaluated for celiac disease, it might be good to consider getting checked for celiac disease, even if these changes are not officially implemented in America anytime soon. Changes in diagnostic and treatment practices that benefit people with celiac disease are long overdue and highly welcomed by the celiac community. As our abilities to evaluate diagnostic and treatment practices continue to expand, look for important changes in the clinical approach to celiac disease, greater awareness among the general population, and improvements in the quality of life among celiacs. References: 1. The Economic Burden of Coeliac Disease in the UK research paper 2. Recent advances in Coeliac Disease by D.A. van Heel and J. West, published in Gut 2006 55, pp 1037-1046 3. Coeliac Society of the UK
  15. Mayo Clin Proc 2004;79:476-482. Celiac.com 05/25/2004 - The results of a study conducted by Dr. G. Richard Locke III and colleagues at the Mayo Clinic College of Medicine in Rochester, Minnesota do not show an association between irritable bowel syndrome (IBS) and celiac disease. The case-control study was based on the respondents of a bowel disease questionnaire that was sent to random Olmsted County residents who were 20 to 50 years old. The researchers evaluated 150 subjects, 72 of whom reported having symptoms of IBS and dyspepsia, and 78 controls with no gastrointestinal symptoms. In the group with symptoms they found that 50 had IBS, 24 had dyspepsia and 15 had both conditions. Serological screening of both groups for celiac disease showed no significant difference between them—two controls, two IBS subjects and two people with dyspepsia tested positive for celiac disease. The researchers conclude that celiac disease alone cannot explain the presence or IBS or dyspepsia in the subjects. The results of this study are interesting, but probably not large enough to be statistically significant. The total number of people with celiac disease in each group was astounding: 2 out of 50 with IBS (4%) 2 out of 24 with dyspepsia (6%) 2 of the 78 controls (2.6%) These findings do not necessarily contradict previous IBS/celiac disease studies that looked at hospital outpatients who are more likely to have more severe and prolonged symptoms than a group that selects itself from the general public by responding to a questionnaire. Additionally most of the earlier studies that concluded that there was a connection between celiac disease and IBS were conducted before more recent epidemiological studies that have shown just how high the incidence of celiac disease in the general population is--now estimated between 0.8% and 1.3%--this study suggests 2 -3%. These recent epidemiological studies have also shown that a large percentage of celiacs have little or no symptoms, perhaps due to the length of time or the severity of the disease. A 1 in 20 diagnosis of celiac disease in patients with IBS/dyspepsia is consistent with other studies, and is still high and suggests that testing for celiac disease should be done routinely on these patients. No studies have ever suggested that all or even most IBS patients have celiac disease, just that the incidence is higher than that of the normal population. I propose that if this study had been done on exactly the same people several years from now, the 2 people in the control group who were found to have celiac disease may well develop symptoms that would put them in either the IBS or dyspepsia group, which would create a statistically significant result that would contradict this studys result. Last, perhaps the results of this study really support a more broad conclusion: Everyone ought to be screened for celiac disease, not just those with symptoms.
  16. Celiac.com 09/30/2002 - The Canadian Medical Association Journal (Hoey, 2002;166:479-80) published the following, Irritable Bowel Syndrome: Could it be Celiac Disease?, as excerpted below. This was an analysis of a Lancet article (Sander et al, 2001;358:1504-8) called, Association of Adult Coeliac Disease with Irritable Bowel Syndrome: A Case-Control Study in Patients Fulfilling Rome II Criteria Referred to Secondary Care. Here are the CMAJ excerpts: Irritable Bowel Syndrome is found in 10% to 20% of people with the use of standard diagnostic tools such as the Rome II criteria. Rome II criteria is specified below: At least 12 weeks, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that has 2 out of 3 features: Relieved with defecation Onset associated with a change in frequency of stool Onset associated with a change in form (appearance) of stool Symptoms that cumulatively support the diagnosis of irritable bowel syndrome: Abnormal stool frequency (more than 3 bowel movements per day or fewer than 3 bowel movements per week) Abnormal stool form (lumpy/hard or loose/watery stool) Abnormal stool passage (straining, urgency or feeling of incomplete evacuation) Passage of mucus Bloating or feeling of abdominal distention Question: What proportion of patients who meet the Rome II criteria for irritable bowel syndrome have celiac disease? Case subjects: The article cites that 300 people (214 women, 86 men ranging in age from 18 to 87, (mean 56 years)) met the Rome II criteria out of 686 new patients who were referred by a family physician to a university hospital gastroenterology clinic. Control subjects were healthy people without irritable bowel syndrome. Also, most control subjects were companions of the patients who were matched to case subjects by age (within 1 year) and sex, as well as questioned in the same manner as case subjects. All case and control subjects underwent a wide range of baseline investigations, including full blood count, measurement of erythrocyte sedimentations rate, blood urea nitrogen and serum electrolyte levels, and thyroid function tests. In addition, they were investigated for celiac disease by analysis of serum levels of IgG antigliadin, IgA antigliadin and endomysial antibodies. Most of the case subjects, particularly those older than 45, underwent colonoscopy or sigmoidoscopy and barium enema. Case and control subjects with positive antibody test results were offered duodenal biopsy to confirm the possibility of celiac disease. Of the 66 case subjects who had positive antibody test results, 49 had elevated levels of only IgG antigliadin 4 of only IgA antigliadin and 6 of only endomysial antibodies Fourteen of the 66 were subsequently found to have histologic evidence of celiac disease; 11 of the 14 were positive for endomysial antibodies. Nine of the of 66 case subjects were lost to follow-up or refused duodenal biopsy; 1 of them was positive for endomysial antibodies. Of the 44 control subjects who had positive antibody test results, 41 had elevated levels of only IgG antigliadin 1 of only IgA antigliadin and 2 of IgG antigliadin and endomysial antibodies Only the last 2 subjects elected to undergo duodenal biopsy, and both were found to have histologic evidence of celiac disease. Commentary: The authors found that a high proportion of patients (about 5%) who were referred to a university hospital gastroenterology clinic and who met the Rome II criteria did have celiac disease. In addition, the clinic specialists uncovered other organic abnormalities in almost 20% of the referred patients. The study had several weaknesses. For instance, although most of the case subjects underwent extensive investigations of the lower gastrointestinal tract, the control subjects did not. Thus, some of the case subjects who were lost to follow-up or refused investigation and many of the age-matched control subjects might have been found to have irritable bowel disease, celiac disease or other gastrointestinal abnormalities. The authors conclude from their findings that patients who meet the Rome II criteria for irritable bowel syndrome and who are referred to a secondary care centre should be investigated routinely for celiac disease. In an editorial accompanying the Lancet article, a gastroenterologist cautioned that more studies are needed. He noted an earlier study in which 121 consecutive patients were referred for investigation of irritable bowel syndrome. Using Rome I criteria and similarly extensive investigation, the researchers detected no cases of celiac disease. Because of the findings from the Lancet study, the editorialist has decided to further lower his threshold for screening for celiac disease among patients referred for investigation of irritable bowel syndrome. Perhaps other gastroenterologists would be wise to do the same. I verified the five percent as cited in the CMAJ as 14 out of the 300 patients who met the Rome II criteria also had celiac disease. The CMAJ also cites the following, Studies in Europe have shown that up to 1% of the adult population may have celiac disease. We can make our own conclusions from this study in Lancet and we might agree that 1% may be understated but further studies have to be performed to corroborate a higher percentage of undiagnosed celiacs; I hope this definitely encourages closer scrutiny of IBS patients like myself who was diagnosed with IBS in 1997 with only a symptom of left side tenderness below my rib cage and a sigmoidoscopy which revealed no abnormalities except a hemorrhoid. Then, in the summer of 2001, I was diagnosed with lactose intolerance and IBS once more before discovering from medical research and my food dairy taken since May 2001, along with corroboration by an allergist in October 2001, that it may be celiac disease, as my malabsorption symptoms grew worse.
  17. Lancet Nov 2001 Volume 358, Number 9292 1504-08 03 Celiac.com 11/14/2001 - A recent study published in The Lancet by Dr. David S Sanders et al. of the Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK, explored the number of people who were diagnosed with irritable bowel syndrome but actually had celiac disease. The case-control study was done at a university hospital in which 300 consecutive new irritable bowel syndrome patients who met the Rome II criteria for their diagnosis were compared against 300 healthy age and sex-matched controls. Both groups were investigated for celiac disease by analysis of their serum IgA antigliadin, IgG antigliadin, and endomysial antibodies (EMA). Patients and controls with positive antibody results were offered duodenal biopsy to confirm the possibility of celiac disease. An amazing 66 patients with irritable bowel syndrome tested positive for the antibodies, and 14 of them or 4.6% had active celiac disease as compared with 2 or 0.66% of the non-IBS matched controls. In other words there is a sevenfold increase over the normal population in the number of people with IBS who have celiac disease. All of the patients with celiac disease in the IBS group were therefore misdiagnosed. The study did not indicate how many of the other 52 patients who had positive antibody results would eventually develop celiac disease, but this would be an interesting follow-up study. Celiac.com believes that the 4.6% with celiac disease will grow higher over time. Conclusion: All patients with irritable bowel syndrome should be screened celiac disease.
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