Prevalence of coeliac disease in adult patients with symptoms of irritable bowel syndrome: a pilot study

ABSTRACT

The aim of this work is to estimate the prevalence and the potential clinical consequences of coeliac disease testing in adult Arab patients with IBS, and estimating the efficacy of IgA and IgG anti-gliadin antibodies, anti endomysial antibodies [EMA] IgA and anti-TG2 [IgA and IgG] on diagnosing celiac disease. As few recent studies have found higher prevalence of coeliac disease among patients diagnosed as irritable bowel syndrome [IBS] than general population [3-11% vs. 0.2-0.6%]. Similar studies showed that coeliac disease is as common in Middle Eastern countries as in Europe; in both the general population and at-risk groups. This is a prospective pilot study including 320 Arab patients with features compatible with IBS as defined by Rome III criteria without any other co-morbidity. The age of patients ranged between18-70 years. All patients were subjected to good history taking, clinical examination, and some investigations if needed such as stool, urine, CBC, liver enzymes, kidney function tests, ECG, electrolytes, H pylori serology, upper and lower endoscopy when indicated. Those diagnosed as having persistent criteria of IBS were tested for coeliac disease by IgA and IgG anti-gliadin antibodies, anti endomysial antibodies [EMA] IgA and anti-TG2 [IgA and IgG]. Upper endoscopy and duodenal biopsies were done and gluten free diet was implemented for only those with positive serological test. The same tests were repeated after period of about 6 months. Anti-gliadin antibodies were found positive in 15/320[4.69%] patients [14 with IgA and 13 IgG], EMA IgA in 13/320 [4.06%], anti-TG2 IgA in 12/320 [3.76%] and anti- TG2 IgG in 13/320 [4.06%]. Abdominal pain, diarrhea, dyspepsia, postprandial distress, epigastric pain, distension and chronic diarrhea were significantly higher and more common in combinations in those with positive serology in comparison to serologically negative patients [P < 0.05]. Haemoglobin level, serum iron, albumin and calcium were found to be significantly lower in those with positive serology in comparison to serologically negative patients [P < 0.05]. All these parameters improved significantly after gluten free died [GFD] for about 6 months [P< 0.05]. Only 11 patients [74.44% of those with positive serology and 3.49% of total patients] were diagnosed by biopsies as compatible with coeliac disease of which, two patients have family history of coeliac disease in first degree relatives. After gluten free died [GFD] for about 6 months, seroconversion to negative tests occurred in 6 patients for AGA-IgA, 4 for AGA- IgG, 3 for EMA IgA, 5 for Anti-TG2 IgA and 5 for Anti-TG2 IgG. Also, the grade of histopathology showed complete healing in 4 patients and improvement to lower grades in 4 patients after GFD. Worsening occurred in one case and still 7 cases showed the same grade of the disease. It is concluded from this study that minimally symptomatic coeliac disease can easily be mistaken for IBS. The presence of many persistent gastrointestinal symptoms in addition to the lower serum levels of some nutritional parameters must alert the physicians to screen for coeliac disease. The efficacy of IgA and IgG anti-gliadin antibodies, anti endomysial antibodies [EMA] IgA and anti-TG2 [IgA and IgG] were nearly the same. So any serological test can be used for the screening, especially EMA TG2 as they are easier and cheap. But this must be confirmed by tissue diagnosis which is the gold standard for diagnosis. Finally, screening for coeliac disease among patients with IBS must be considered to offer better prognosis to those patients simply by gluten free diet