title: The prevalence of celiac disease among patients with nonconstipated irritable bowel syndrome is similar to controls.
abstract: OBJECTIVE
  Guidelines recommend that patients with symptoms of nonconstipated irritable bowel syndrome (NC-IBS) undergo testing for celiac disease (CD). We evaluated the prevalence of CD antibodies, and biopsy confirmed CD among patients with NC-IBS in a large US population.
  
  
  METHODS
  In a study conducted at 4 sites, from 2003 to 2008, we compared data from 492 patients with symptoms of NC-IBS to 458 asymptomatic individuals who underwent colonoscopy examinations for cancer screening or polyp surveillance (controls). All participants provided blood samples for specific and nonspecific CD-associated antibodies. Additionally, patients with IBS were analyzed for complete blood cell counts, metabolic factors, erythrocyte sedimentation rates, and levels of C-reactive protein and thyroid-stimulating hormone. Any subjects found to have CD-associated antibodies were offered esophagogastroduodenoscopy and duodenal biopsy analysis.
  
  
  RESULTS
  Of patients with NC-IBS, 7.3% had abnormal results for CD-associated antibodies, compared with 4.8% of controls (adjusted odds ratio, 1.49; 95% confidence interval: 0.76-2.90; P=.25). Within the NC-IBS group, 6.51% had antibodies against gliadin, 1.22% against tissue transglutaminase, and 0.61% against endomysium (P>.05 vs controls for all antibodies tested). CD was confirmed in 0.41% of patients in the NC-IBS group and 0.44% of controls (P>.99).
  
  
  CONCLUSIONS
  Although CD-associated antibodies are relatively common, the prevalence of CD among patients with NC-IBS is similar to that among controls in a large US population. These findings challenge recommendations to routinely screen patients with NC-IBS for CD. More than 7% of patients with NC-IBS had CD-associated antibodies, suggesting that gluten sensitivity might mediate IBS symptoms; further studies are needed.
authors.affiliation: Uniformed Services University of the Health Sciences, National Naval Medical Center, Bethesda, Maryland 20889-5000, USA. brooks.cash@med.navy.mil
authors.forename: Brooks D
authors.initials: BD
authors.lastname: Cash
authors.forename: Joel H
authors.initials: JH
authors.lastname: Rubenstein
authors.forename: Patrick E
authors.initials: PE
authors.lastname: Young
authors.forename: Andrew
authors.initials: A
authors.lastname: Gentry
authors.forename: Borko
authors.initials: B
authors.lastname: Nojkov
authors.forename: Dong
authors.initials: D
authors.lastname: Lee
authors.forename: A Hirsohi
authors.initials: AH
authors.lastname: Andrews
authors.forename: Richard
authors.initials: R
authors.lastname: Dobhan
authors.forename: William D
authors.initials: WD
authors.lastname: Chey
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood; D001706:Biopsy; D016022:Case-Control Studies; D002446:Celiac Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000473:pathology; D016009:Chi-Square Distribution; D003113:Colonoscopy; D004386:Duodenum / Q000473:pathology; D005260:Female; D019204:GTP-Binding Proteins; D005903:Gliadin / Q000276:immunology; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D018570:Risk Assessment; D012307:Risk Factors; D011503:Transglutaminases / Q000276:immunology; D014481:United States / Q000453:epidemiology
chemical_list: D001323:Autoantibodies; D005903:Gliadin; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins