Celiac disease hidden among IBS patients?
Diarrhea, abdominal cramps, and relief following a bowel movement are symptoms shared by different gastrointestinal conditions. To ensure an accurate diagnosis, researchers now recommend routine blood test screening for celiac disease in patients who have irritable bowel syndrome (IBS) symptoms.1
In a recent study published in The European Journal of Internal Medicine,2 researchers assessed the prevalence of celiac disease in patients who fulfilled the Rome III criteria for IBS, which is the standard list of specific symptoms that physicians currently use to diagnose IBS. (See below.)
The researchers approached 1,380 patients at a gastroenterology clinic in Turkey during a four-month period, screening for patients who fulfilled the Rome III criteria for IBS. Patients were excluded from the study for a number of reasons, including advanced age (>65 years), the presence of any alarming symptoms (e.g., weight loss, family history of IBD or cancer, fever, arthritis, dermatitis, anemia), any kind of gastrointestinal malignancy, diabetes, hyper- or hypo-thyroidism, heart failure, cirrhosis, severe depression, history of continuous drug use, and others.
Of the 1,380 approached, 100 patients qualified for the study and were tested for celiac disease using the Biocard™ Celiac Test (now called CeliacSure™), a commercially available home blood test kit. Two female participants tested positive for celiac disease and underwent additional laboratory blood testing and intestinal biopsy confirmation.
Numerous other studies have shown similar rates of celiac disease among patients who fulfilled the diagnostic criteria for IBS, using Rome I, Rome II, and the even older Manning criteria, but this is the first study to use the latest Rome III criteria.
The researchers say that even though many gastroenterologists support the idea of screening for celiac disease when considering an IBS diagnosis, it is not yet an established practice. Studies have shown the Health Canada approved CeliacSure™ test, which requires only one blood drop from a finger pinprick, to have an overall accuracy of 93.5%, the same as testing in a laboratory.3
If you suspect you have celiac disease, or have taken the CeliacSure™ test at home, it is very important that you do not begin a gluten-free diet until a physician examines you. Removing gluten from your diet before seeing your doctor can actually make it more difficult to rule out or confirm a celiac disease diagnosis. Similarly, if you experience unexplained symptoms, such as weight loss, fatigue, diarrhea, constipation, alternating diarrhea and constipation, or abdominal pain, then make an appointment with your physician to determine the cause of your symptoms and to obtain appropriate treatment.
The Rome Foundation
The Rome III criteria were developed by a nonprofit organization, the Rome Foundation, which includes respected members from the international medical community who work together to define the best criteria for diagnosing functional gastrointestinal conditions, including IBS and functional dyspepsia.
Rome III Diagnostic Criteria for Irritable Bowel Syndrome
At least three months, with onset at least six months previously, of recurrent abdominal pain or discomfort* associated with two or more of the following:
- Improvement with defecation; and/or
- Onset associated with a change in frequency of stool; and/or
- Onset associated with a change in form (appearance) of stool.
*Discomfort means an uncomfortable sensation not described as pain.
Note: In 2016, the Rome Foundation updated the diagnostic criteria for IBS to the Rome IV criteria.