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Screening for Celiac Disease in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis

Irvine, Andrew J MBChB, BMedSci1,2; Chey, William D MD, FACG, AGAF, FACP, RFF3; Ford, Alexander C MBChB, MD, FRCP1,2

American Journal of Gastroenterology: January 2017 - Volume 112 - Issue 1 - p 65–76
doi: 10.1038/ajg.2016.466
REVIEW: CLINICAL AND SYSTEMATIC REVIEWS
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Objectives: Celiac disease (CD) and irritable bowel syndrome (IBS) share similar symptoms, leading to confusion between the two and diagnostic delay. International guidelines recommend screening individuals with IBS for CD, via serological testing. However, studies published recently have cast doubt on the utility of this. We updated a previous meta-analysis examining this issue.

Methods: MEDLINE, EMBASE, and EMBASE Classic were searched through to May 2016. Eligible studies recruited adults with IBS according to symptom-based criteria, physician’s opinion, or questionnaire data. Tests for CD included IgA-class antigliadin antibodies (AGA), endomysial antibodies (EMA), tissue transglutaminase antibodies (tTG), or duodenal biopsies following positive serology. The proportion of individuals meeting criteria for IBS testing positive for CD was combined to give a pooled prevalence for all studies, and compared between cases with IBS and, healthy controls without (where reported), using an odds ratio (OR) with a 95% confidence interval (CI).

Results: There were 36 eligible studies, recruiting 15,256 individuals, of whom 9,275 (60.8%) met criteria for IBS. Pooled ORs for positive IgA AGAs, EMA and/or tTG, and biopsy-proven CD in IBS subjects vs. controls were 3.21 (95% CI 1.55–6.65), 2.75 (95% CI 1.35–5.61), and 4.48 (95% CI 2.33–8.60), respectively. There was no increase in ORs for any test for CD among cases with IBS in North American studies, and results were inconsistent in population-based studies. The prevalence of biopsy-proven CD was significantly higher across all subtypes of IBS. Limitations included heterogeneity in some analyses, and few North American studies.

Conclusions: Overall, prevalence of positive celiac serology and biopsy-proven CD was significantly higher in subjects with symptoms suggestive of IBS vs. healthy controls. However, the utility of screening for CD in individuals with suspected IBS in North America or in the community is less clear.

1Leeds Gastroenterology Institute, St James’s University Hospital, Leeds, UK

2Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK

3Department of Internal Medicine, Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA

Correspondence: Alexander C. Ford, Leeds Gastroenterology Institute, St James’s University Hospital, Room 125, 4th Floor, Bexley Wing, Beckett Street, Leeds, LS9 7TF UK. E-mail: alexf12399@yahoo.com

Received 01 June 2016; accepted 13 September 2016

Guarantor of the article: Alexander C. Ford, MBChB, MD, FRCP.

Specific author contributions: Collected all data: Andrew J. Irvine and Alexander C. Ford. Analyzed and interpreted the data: Alexander C. Ford. All authors conceived and drafted the study, contributed to, and approved the final draft of the manuscript.

Financial support: None.

Potential competing interests: None.

© The American College of Gastroenterology 2017. All Rights Reserved.
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