ABSTRACT
Background and study aims: the clinical presentation of coeliac disease can vary from a classical malabsorption syndrome to more subtle atypical gastrointestinal manifestations similar to irritable bowel syndrome [IBS]. The aim of this study was to investigate the prevalence of coeliac disease in Egyptian patients with clinically diagnosed diarrhoea-predominant IBS [according to Rome III criteria]
Patients and methods: this study was conducted on 100 patients with clinically diagnosed diarrhoea-predominant IBS [fulfilling Rome III criteria]. They were subjected to complete clinical evaluation, routine laboratory investigations, abdominal ultrasonography and serum anti-tissue transglutaminase antibody [anti-tTG] test as a predictor marker for coeliac disease. All patients who tested positive for serum anti-tTG underwent upper gastrointestinal endoscopy with four to eight biopsy sample collected from the second part of the duodenum
Results: all of the studied 100 patients presented with abdominal pain or discomfort, flatulence and diarrhoea. Eight patients [8%] exhibited high levels of serum anti-tTG, and their duodenal biopsy samples satisfied the histopathological criteria of coeliac disease. The studied patients were divided into two group: Group I comprising 92 patients with IBS and negative anti-tTG results and Group II comprising eight patients with IBS and positive anti-tTG results. A non-significant difference was noted between the two groups in age, gender and duration of abdominal pain [p>0.05]. The haemoglobin level was found to be significantly reduced in anti-tTG-positive patients [p<0.01], as was the Na level in anti-tTG-negative patients [p<0.05]. A highly statistically significant inverse correlation was noted between anti-tTG and both serum total protien and serum albumin
Conclusion: some symptoms overlap between coeliac disease and IBS. A lack of awareness may lead to a diagnostic delay in these patients