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1. Irritable Bowel Syndrome and screening for Celiac Disease

   • hussam M ammar, MD
   • Hesham Ammar, Ragai M Fouda

   Heartland Regional Medical Center, St. Joseph MO 64501

   Celiac disease can be mistakenly labeled as Irritable Bowel syndrome (IBS). In a widely cited study, 14 patients (4.7%) of 300 cases who met the Rome II criteria for the diagnosis of IBS had celiac sprue confirmed by duodenal biopsy (1). We disagree with a statement in the recent comprehensive review on IBS describing antigliadin antibodies as both sensitive and specific antibodies for screening for celiac disease (2).

   Recent recommendations by a consensus panel from the National Institute of Health stated that Antigliadin antibody (AGA) tests are no longer routinely recommended for celiac disease screening because of their lower sensitivity and specificity(3). IgA anti–transglutaminase antibody and IgA antiendomysial antibody have a sensitivity greater than 90% and a specificity greater than 95% which made them the serological markers of choice(3,4). An important caveat is to remember that Selective IgA deficiency occurs in 1·7%–2·6% of patients with celiac disease, a rate ten to 16-fold higher than that in the general population. All serological markers based on IgA antibodies will be falsely negative in patients with IgA deficiency. A test for IgG antibodies (either IgG endomysial antibodies, IgG anti- transglutaminase , or AGA IgG) should be done in these circumstances. It is advisable to include total serum IgA in the initial screening panel(4,5).

   References

   1-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;358:1504-8.

   2-Wilson JF. In the clinic. Irritable bowel syndrome. Ann Intern Med. 2007 Jul 3;147(1):ITC7-1-ITC7-16. Review.

   3-National Institutes of Health?

   (NIH) Consensus Development Conference on Celiac Disease Statement June 28–30, 2004. Retrieved July 17,2007 from NIH web site: http://consensus.nih.gov/2004/2004CeliacDisease118html.htm

   4- Alaedini A, Green PH. Narrative review: celiac disease: understanding a complex autoimmune disorder. Ann Intern Med. 2005 Feb 15;142(4):289-98. Review.

   5- Green PH, Jabri B. Celiac disease. Lancet. 2003; 362:383-91.

   Conflict of Interest:

   None declared

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   Published July 19, 2007