CC BY-NC-ND 4.0 · Journal of Coloproctology 2022; 42(01): 020-024
DOI: 10.1055/s-0041-1736645
Original Article

Screening for Celiac Disease in Patients with Irritable Bowel Syndrome Fulfilling Rome III Criteria

1   Department of Medicine, University of Ninevah, Ninevah College of Medicine, Mosul, Iraq
› Author Affiliations

Abstract

Background Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. Celiac disease (CD), a treatable autoimmune enteropathy, with varied presentations, may simulate clinically symptoms of IBS. The aim of the present study is to screen for CD in patients with IBS diagnosed based on the Rome III criteria.

Patients and Methods A cross-sectional study was conducted at a secondary care gastrointestinal unit in Al-Salam General Hospital in Mosul city, Iraq, from November 2015 to October 2016. All patients fulfilling the Rome III criteria for IBS were screened for CD using antitissue transglutaminase IgA antibodies (anti-tTG). Patients who tested positive were subjected to endoscopic duodenal biopsy to confirm the diagnosis of CD.

Results A total of 100 patients were included in the present study (58 female and 42 male), the mean age of the participants was 40.8 years old (standard deviation [SD] ± 11.57). Ten patients (10/100, 10%) tested positive for anti-tTG antibodies. Five of the seropositive patients (5/10, 50%) showed positive biopsy results according to the Marsh classification, 3 of whom having diarrhea, and 2 with constipation.

Conclusion Positive serology and biopsy results suggestive of CD are common among patients with IBS. Screening patients with IBS for CD is justified.

Ethical Approval

Ethical approval was granted by the Medical Ethics Committee of the Ninevah University.


Informed Consent

All participant agreed to sign an informed written consent form.


Note

Hospital-based study supported by Iraqi ministry of health. The patients were not charged, and no charge was received by the author.




Publication History

Received: 21 March 2021

Accepted: 15 June 2021

Article published online:
18 November 2021

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  • References

  • 1 Brandt LJ, Chey WD, Foxx-Orenstein AE. et al; American College of Gastroenterology Task Force on Irritable Bowel Syndrome. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 2009; 104 (Suppl. 01) S1-S35
  • 2 Drossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowel syndrome. Gastroenterology 2002; 123 (06) 2108-2131
  • 3 Lacy BE, Patel NK. Rome Criteria and a Diagnostic Approach to Irritable. Bowel Syndrome. J Clin Med 2017; 06 (11) 1-8
  • 4 Di Sabatino A, Corazza GR. Coeliac disease. Lancet 2009; 373 (9673): 1480-1493
  • 5 West J, Logan RF, Hill PG. et al. Seroprevalence, correlates, and characteristics of undetected coeliac disease in England. Gut 2003; 52 (07) 960-965
  • 6 Malekzadeh R, Sachdev A, Fahid Ali A. Coeliac disease in developing countries: Middle East, India and North Africa. Best Pract Res Clin Gastroenterol 2005; 19 (03) 351-358
  • 7 Wahnschaffe U, Ullrich R, Riecken EO, Schulzke JD. Celiac disease-like abnormalities in a subgroup of patients with irritable bowel syndrome. Gastroenterology 2001; 121 (06) 1329-1338
  • 8 Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS. Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis. Gastroenterology 2004; 126 (07) 1721-1732
  • 9 Ford AC, Chey WD, Talley NG. et al. Yeild of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. Arch Intern Med 2009; 169 (07) 651-658
  • 10 Hin H, Bird G, Fisher P, Mahy N, Jewell D. Coeliac disease in primary care: case finding study. BMJ 1999; 318 (7177): 164-167
  • 11 Cash BD, Rubenstein JH, Young PE. et al. The prevalence of celiac disease among patients with nonconstipated irritable bowel syndrome is similar to controls. Gastroenterology 2011; 141 (04) 1187-1193
  • 12 Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology 2006; 130 (05) 1480-1491
  • 13 Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol 1999; 11 (10) 1185-1194
  • 14 Burbige EJ. Irritable bowel syndrome: diagnostic approaches in clinical practice. Clin Exp Gastroenterol 2010; 3: 127-137
  • 15 Frissora CL, Koch KL. Symptom overlap and comorbidity of irritable bowel syndrome with other conditions. Curr Gastroenterol Rep 2005; 7 (04) 264-271
  • 16 Zintzaras E, Germenis AE. Performance of antibodies against tissue transglutaminase for the diagnosis of celiac disease: meta-analysis. Clin Vaccine Immunol 2006; 13 (02) 187-192
  • 17 Sanders DS, Carter MJ, Hurlstone DP. et al. Association of adult coeliac disease with irritable bowel syndrome: a case-control study in patients fulfilling ROME II criteria referred to secondary care. Lancet 2001; 358 (9292): 1504-1508
  • 18 Sanders DS, Patel D, Stephenson TJ. et al. A primary care cross-sectional study of undiagnosed adult coeliac disease. Eur J Gastroenterol Hepatol 2003; 15 (04) 407-413
  • 19 Fasano A, Berti I, Gerarduzzi T. et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 2003; 163 (03) 286-292
  • 20 Shahbazkhani B, Forootan M, Merat S. et al. Coeliac disease presenting with symptoms of irritable bowel syndrome. Aliment Pharmacol Ther 2003; 18 (02) 231-235
  • 21 Jadallah KA, Khader YS. Celiac disease in patients with presumed irritable bowel syndrome: a case-finding study. World J Gastroenterol 2009; 15 (42) 5321-5325
  • 22 Korkut E, Bektas M, Oztas E, Kurt M, Cetinkaya H, Ozden A. The prevalence of celiac disease in patients fulfilling Rome III criteria for irritable bowel syndrome. Eur J Intern Med 2010; 21 (05) 389-392
  • 23 El-Salhy M, Lomholt-Beck B, Gundersen D. The prevalence of celiac disease in patients with irritable bowel syndrome. Mol Med Rep 2011; 4 (03) 403-405
  • 24 Irvine AJ, Chey WD, Ford AC. Screening for Celiac Disease in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis. Am J Gastroenterol 2017; 112 (01) 65-76
  • 25 Almazar AE, Talley NJ, Larson JJ, Atkinson EJ, Murray JA, Saito YA. Celiac disease is uncommon in irritable bowel syndrome in the USA. Eur J Gastroenterol Hepatol 2018; 30 (02) 149-154
  • 26 Mohammad BY, Al-Dohouky L, Mohammed AA. Prevalence of anti-tissue transglutaminase antibodies in patients with irritable bowel syndrome in Duhok city. J Coloproctol (Rio J) 2019; 39 (04) 346-350
  • 27 Ludvigsson JF, Leffler DA, Bai JC. et al. The Oslo definitions for coeliac disease and related terms. Gut 2013; 62 (01) 43-52
  • 28 Hill ID, Dirks MH, Liptak GS. et al; North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2005; 40 (01) 1-19
  • 29 Donaldson MR, Firth SD, Wimpee H. et al. Correlation of duodenal histology with tissue transglutaminase and endomysial antibody levels in pediatric celiac disease. Clin Gastroenterol Hepatol 2007; 5 (05) 567-573
  • 30 Spijkerman M, Tan IL, Kolkman JJ. et al. A large variety of clinical features and concomitant disorders in celiac disease - A cohort study in the Netherlands. Dig Liver Dis 2016; 48 (05) 499-505
  • 31 Vazquez-Roque MI, Camilleri M, Smyrk T. et al. A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function. Gastroenterology 2013; 144 (05) 903-911.e3