Irritable bowel syndrome: how far do you go in the workup?

Content Provider	Semantic Scholar
Author	Drossman, Douglas A.
Copyright Year	2001
Abstract	Background & Aims: Abdominal symptoms in the absence of mucosal abnormalities are features of both the irritable bowel syndrome (IBS) and latent/potential celiac disease (cd). To identify a possible subgroup of IBS patients with latent/potential cd, surrogate markers of cd were investigated in IBS patients. Methods: IBS patients suffering from diarrhea (n = 102), and patients with active cd (n = 10), treated cd (n = 26), and latent cd (n = 5) were included in the study. We measured serum immunoglobulin (Ig) A against gliadin and tissue-transglutaminase, and IgA and IgM against gliadin, tissue-transglutaminase (intestinal cd-associated antibodies), and the dietary proteins β-lactoglobulin and ovalbumin in duodenal aspirate by enzyme-linked immunosorbent assay. Intraepithelial lymphocytes (IELs) were counted in histology sections, and the expression of HLA-DQ2 (A1 * 0501/B1 * 0201) was investigated by polymerase chain reaction. In 26 IBS patients, the effect of 6 months of gluten withdrawal was examined. Results: Most cd patients expressed HLA-DQ2 and had increased intestinal cd-associated antibodies, whereas cd-associated serum IgA and IEL counts were increased in active cd in contrast to treated or latent cd. In IBS patients, 35% were HLA-DQ2-positive, 23% had increased IEL counts, and 0% and 30% had increased cd-associated antibodies in serum and duodenal aspirate, respectively. Furthermore, stool frequency and intestinal IgA decreased significantly under a gluten-free diet in the subgroups of HLA-DQ2-positive and intestinal antibody-positive IBS patients when compared with IBS patients without these markers. Conclusions: HLA-DQ2 expression and increased intestinal cd-associated antibodies are markers that can identify latent/potential cd in a subgroup of IBS patients who consequently appear to profit from a gluten-free diet.
File Format	PDF HTM / HTML
DOI	10.1053/gast.2001.29782
PubMed reference number	11729133
Journal	Medline
Volume Number	121
Issue Number	6
Alternate Webpage(s)	http://www.med.unc.edu/ibs/files/educational-gi-handouts/IBS%20Workup.pdf
Alternate Webpage(s)	http://drossmangastroenterology.com/download/dianosis/IBS%20Workup.pdf
Alternate Webpage(s)	https://doi.org/10.1053/gast.2001.29782
Journal	Gastroenterology
Language	English
Access Restriction	Open
Content Type	Text
Resource Type	Article