Advertisement
Mayo Clinic Proceedings Home

Celiac Disease Serology and Irritable Bowel Syndrome: Does the Relationship Merit Further Evaluation?

      To the Editor: We read with interest the study by Locke et al
      • Locke III, GR
      • Murray JA
      • Zinsmeister AR
      • Melton III, LJ
      • Talley NJ
      Celiac disease serology in irritable bowel syndrome and dyspepsia: a population-based case-control study.
      in the April 2004 issue of Mayo Clinic Proceedings on the prevalence of celiac disease serology in individuals with well-categorized irritable bowel syndrome (IBS) and dyspepsia in a primary care setting. The authors observed that the prevalence of tissue transglutaminase (TTg) was 4% (2/50), but because these individuals were endomysial antibody-negative, they did not undergo duodenal biopsy. The authors concluded that celiac disease does not explain the IBS symptoms in the vast majority of patients in a US primary care population. We were surprised by this conclusion for several reasons.
      Endomysial antibody-negative celiac disease in the presence of TTg positivity has been well described.
      • Dickey W
      • McMillan SA
      • Hughes DF
      Sensitivity of serum tissue transglutaminase antibodies for endomysial antibody positive and negative coeliac disease.
      Therefore, the 2 patients with IBS and positive TTg tests could have had celiac disease-we will never know without duodenal biopsy.
      In our primary care-based study in the United Kingdom, we observed that the prevalence of Rome II criteria IBS was 10.25% (123/1200) and that the prevalence of undiagnosed celiac disease in this cohort was 3.3% (4/123),
      • Sanders DS
      • Patel D
      • Stephenson TJ
      • et al.
      A primary care cross-sectional study of undiagnosed adult coeliac disease.
      a prevalence similar to that observed by Locke et al.
      Fasano et al
      • 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.
      recently showed that case finding for celiac disease in high-risk groups in the United States reveals a hidden iceberg-the disease appears to be more common than previously recognized, as are delays in diagnosis. In addition, patients clearly benefit symptomatically from a gluten-free diet.
      • Sanders DS
      There is a relationship between celiac disease and patients with symptoms of irritable bowel syndrome [letter].
      Finally, given the sample size in the study by Locke et al (n=50), their study had only a 20% power to predict a 3-fold relative risk (assuming a .05 significance level).
      In view of these observations, we believe that it is imperative that we are more circumspect about dismissing a possible link between IBS and celiac disease. Larger population-based studies are required to help clarify whether this relationship exists in the United States.

      REFERENCES

        • Locke III, GR
        • Murray JA
        • Zinsmeister AR
        • Melton III, LJ
        • Talley NJ
        Celiac disease serology in irritable bowel syndrome and dyspepsia: a population-based case-control study.
        Mayo Clin Proc. 2004; 79: 476-482
        • Dickey W
        • McMillan SA
        • Hughes DF
        Sensitivity of serum tissue transglutaminase antibodies for endomysial antibody positive and negative coeliac disease.
        Scand J Gastroenterol. 2001; 36: 511-514
        • 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: 407-413
        • 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: 286-292
        • Sanders DS
        There is a relationship between celiac disease and patients with symptoms of irritable bowel syndrome [letter].
        Gastroenterology. 2002; 123: 1408