title: Positive coeliac serology in irritable bowel syndrome patients with normal duodenal biopsies: Video capsule endoscopy findings and HLA-DQ typing may affect clinical management.
abstract: OBJECTIVE
  To investigate a group of IBS patients (Rome criteria) with positive coeliac serology (EMA, TTG, IgG or IgA AGA) and normal small bowel biopsies. Video capsule endoscopy (VCE) findings of the small bowell were compared with DQ-typing.
  
  
  METHODS
  Twenty-two patients with chronic abdominal pain (with or without diarrhea) and at least one positive result of any of the coeliac serological markers (AGA, TTG, EMA) and normal duodenal biopsy were enrolled and underwent VCE. Twelve healthy volunteers with VCE served as control group. Coeliac related HLA DQ2 or DQ8 markers were determined.
  
  
  RESULTS
  12/ 22 (55%) patients had small bowel abnormalities with VCE. No mucosal abnormalities were recognized in the control group (p = 0.002). Inflammatory changes were classified as moderate or pronounced. Eight patients (36%) had moderate changes and four patients (18%) demonstrated pronounced changes. Only 6 of the 21 IBS patients were positive for DQ2 and/or DQ8.
  
  
  CONCLUSIONS
  The patients in this study fulfilled the diagnostic Rome criteria for Irritable Bowel Syndrome. We suggest that patients with positive coeliac serology and normal duodenal biopsies should undergo HLA typing. In patients positive for DQ2 and/or DQ8, a VCE should be performed. Patients with mucosal abnormalities compatible with CD should be considered as a group distinct from IBS patients and could be tested with gluten challenge or treated with a gluten free diet.
authors.affiliation: Department of Gastroenterology, Bikur Cholim Hospital, Rechov Straus 5, Jerusalem, Israel. samadler@inter.net.il
authors.forename: Samuel Nathan
authors.initials: SN
authors.lastname: Adler
authors.forename: Harold
authors.initials: H
authors.lastname: Jacob
authors.forename: Graciela
authors.initials: G
authors.lastname: Lijovetzky
authors.forename: Chris J J
authors.initials: CJ
authors.lastname: Mulder
authors.forename: Antonie
authors.initials: A
authors.lastname: Zwiers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy; D004386:Duodenum / Q000473:pathology*; D005260:Female; D005903:Gliadin / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007074:Immunoglobulin G / Q000097:blood*; D043183:Irritable Bowel Syndrome / Q000097:blood* / Q000276:immunology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011503:Transglutaminases / Q000276:immunology
chemical_list: D007070:Immunoglobulin A; D007074:Immunoglobulin G; D005903:Gliadin; D011503:Transglutaminases