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Irritable Bowel Syndrome or Celiac Disease: Hard to Tell the Difference

Is Your IBS Really Celiac Disease?

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Updated July 01, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Can you name a disorder in which patients suffer frequently from abdominal pain, bloating, and diarrhea or constipation? If you said "celiac disease," you'd be right, of course. But if you said "irritable bowel syndrome" (IBS), you'd also be right. In fact, the symptoms of IBS are so similar to the symptoms of celiac disease that the two disorders can be difficult to tell apart. In some cases, patients who've been told they have IBS may actually have celiac disease as well, without realizing it.

Whereas celiac disease affects the small intestine, IBS predominantly affects the colon, or large intestine. The exact cause is unknown. Among the most common features of IBS are abdominal pain or discomfort, cramping, bloating, and gas that may be relieved by a bowel movement. Some people with the disorder have constipation, others have diarrhea, and some have both. Some have a whitish mucus in their stool. Patients can also have nausea, fatigue, a sensation of fullness after even a small meal, and vomiting.

In addition, symptoms of IBS can be made worse by large meals; certain medicines; eating wheat, rye, barley, chocolate, or milk products; drinking alcohol or caffeinated beverages such as coffee, tea, or colas; and stress or conflict.

There is no specific test for IBS. Doctors first look for other disorders that might be causing the patient's symptoms. If they don't find any other medical explanation, they use a list of features called The Rome Criteria to identify patients who might have IBS.

What Should Patients With Irritable Bowel Syndrome Ask Their Doctors About Celiac Disease?

Patients with IBS should discuss the possibility of celiac disease with their doctors. With so many similarities, it's not surprising that medical researchers have found a high rate of celiac disease in patients with IBS. One British study found that the chance of having celiac disease was 7 times higher for patients with IBS than for the general public. In an Iranian study, nearly 10% of patients with IBS also had celiac disease. In these patients, symptoms either improved or disappeared when they adopted a gluten-free diet. In 2009, researchers from Canada and the U.S. reviewed the results of 14 earlier studies involving more than 4000 participants, roughly half of whom had IBS. All participants in the studies were tested for celiac disease. The researchers found that patients with IBS had a prevalence of celiac disease more than 4 times higher than participants without IBS.

Many researchers have recommended that everyone with IBS be automatically tested for celiac disease. When American doctors studied the cost-effectiveness of testing for celiac disease in all patients with suspected IBS, they found that celiac testing would be cost-effective even if it turned out that only a few patients actually had the disease, and even if those few patients had only a small quality-of-life improvement with a gluten-free diet. In December 2008, the American College of Gastroenterology issued updated guidelines advising that any patient with IBS who has diarrhea or a mixture of diarrhea and constipation should be tested for celiac disease.

The bottom line? If you've been diagnosed with IBS, talk to your doctor about tests for celiac disease, too. If you have celiac disease but don't treat it with a gluten-free diet, you're at risk for serious complications.

Sources:

Sanders DS et al. Association of adult coeliac disease with irritable bowel syndrome: a case-control study in patients fulfilling ROME II criteria referred to secondary care. Lancet 2001;358:1504-8.

Shahbazkhani B et al. Coeliac disease presenting with symptoms of irritable bowel syndrome. Aliment Pharmacol Ther 2003;18:231-5.

Mein SM, Ladabaum U. Serological testing for coeliac disease in patients with symptoms of irritable bowel syndrome: a cost-effectiveness analysis. Aliment Pharmacol Ther 2004;19:1199-210.

National Digestive Diseases Information Clearinghouse.

Medline Plus: Irritable Bowel Syndrome

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Ford AC et al. Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. Archives of Internal Medicine 2009;169:651-658.

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