ABSTRACT
Irritable bowel syndrome [IBS] is one of the most common functional gastrointestinal disorders. A significant number of IBS patients have extra-intestinal symptoms [EIS], but the etiology of co-morbidity of IBS with these symptoms is unclear. The aim of this study was to evaluate the relationship of EIS with psychological symptoms in IBS patients. This multicenter, cross-sectional study was conducted on 18 to 65 year old IBS patients [Rome III criteria] referred to four gastroenterology outpatient clinics in the city of Isfahan from 2008-2009. Patients completed the IBS symptom severity scale, EIS severity scale, and anxiety and depression scale. Linear regression analysis was applied to evaluate the relationship of psychological symptoms with EIS, controlling for other variables. During the study period, 142 IBS patients [mean age=30.9 +/- .1 years, 81.7% female] were included. ESI score was significantly correlated to IBS severity score [r=0.534], anxiety [r=0.551] and depression scores [r=0.407]; P<0.001. With linear regression analysis, female gender [P=0.028], IBS severity [P<0.001], and severity of anxiety [P=0.001] were related to ESI scores. According to these results, psychological symptoms are associated with EIS in IBS patients, though prospective studies are needed to evaluate a causative association. Thus, gastroenterologists must pay attention to the association of psychological symptoms with EIS in the treatment of IBS patients and refer them for appropriate therapies
ABSTRACT
Celiac disease [CD] may be misdiagnosed as Irritable Bowel Syndrome [IBS] resulting in long delays in diagnosing CD. There are contradictory reports on the association of CD with IBS. Appropriateness of screening all patients with IBS for CD and how to screen them are still under question. In a cross-sectional study, 328 IBS patients [Rome II] referred to the Poursina Hakim Gastroenterology Clinic were investigated for CD. Total serum anti-tissue transglutaminase IgA [anti-tTG IgA] concentration was measured in all patients. In IgA deficient cases, antigliadin antibody [AGA] IgG concentration was also measured. Moreover, in patients who underwent upper endoscopy [as their necessary workup] duodenal biopsies were taken. Fifty-eight patients were excluded. The remaining patients were 166 [61.5%] women and 104 [38.5%] men with the mean age of 35.3 years [SD = 11.8]. No one had positive serological test of IgA anti tTG antibody. Five patients were IgA deficient; none of them had positive IgG AGA. Duodenal biopsies were taken in 60 patients and pathologic evaluation showed 53Marsh 0, three Marsh I, three Marsh II, and one Marsh IIIa. Only the patient with Marsh IIIa adhered to gluten-free diet [GFD] which led to decrease in severity of symptoms. In patients who did not adhere to GFD, no one had positive serological test after 12 months of follow-up. Prevalence of CD in patients with IBS referred to outpatient gastroenterology clinic might be significant but serum anti-tTG IgA antibody is not helpful in detecting CD in these patients. Further studies are needed to clarify this issue