Systematic review highlights need to test IBS patients for celiac disease
Of 7,209 patients diagnosed with irritable bowel disease (IBS), 6% were seropositive for celiac disease, according to a review of studies conducted in countries where such testing was not routine.
A significant proportion of patients diagnosed with irritable bowel syndrome (IBS) tested positive for celiac disease, a recent systematic review and meta-analysis found.
Researchers included 29 studies published between 2010 and 2024 that reported the prevalence of celiac disease in patients with IBS. All used Rome III or Rome IV criteria for IBS diagnosis and used serological screening with tissue transglutaminase, endomysial antibodies, or deamidated gliadin peptide, and/or confirmatory duodenal biopsies for celiac diagnosis. The results were published by the American Journal of Gastroenterology on June 10.
Among the 7,209 patients with IBS, the pooled seroprevalence of celiac disease was 6% (95% CI, 5% to 8%). Biopsy-proven celiac disease was present in 2% (95% CI, 2% to 3%). Of the seropositive patients, 15% (95% CI, 6% to 24%) did not undergo endoscopy and biopsy. Six studies included control groups of patients without IBS, and patients with IBS had significantly higher odds of being seropositive for celiac disease than controls (odds ratio, 4.42; 95% CI, 2.82 to 6.92).
At 6%, the seroprevalence of celiac disease among IBS patients was “more than fourfold increased odds of a positive serology compared with non-IBS controls,” the study authors noted, adding that the review's findings reinforce current recommendations to exclude celiac disease before making a positive diagnosis of IBS.
Limitations include that few studies were from Europe and none were from the United States.
Because serological screening for celiac has been part of the routine work-up for suspected IBS in the U.S. and Europe for more than a decade, “there is a limited number of contemporary cohorts of untested patients with IBS from these regions,” the authors said.