Differential diagnostics of irritable bowel syndrome and celiac disease
Abstract
The aim of review. To analyze similarity and differences of clinical manifestations and data of additional investigations methods at irritable bowel syndrome (IBS) and celiac disease.
Original positions. Data on pattern of clinical manifestations and basic laboratory and histological markers of celiac disease is cited. Possible similarity of basic signs of IBS and celiac sprue is pointed out, especially at low-symptom, subtle course of the latter. Taking into account essentially different prognosis of these diseases, well-timed recognition and treatment of celiac disease is important. Groups of risk, sensitivity and specificity of various serological tests and information value of histological study of mucosa of small intestine at celiac sprue are presented. Necessity of combined investigation of basic serological markers of celiac sprue – antibodies to tissue transglutaminase and antibodies to endomysium at patients with prospective diagnosis of IBS with diarrhea-predominant and mixed variant is rationalized.
Conclusion. It is necessary to recognize, that according to Rome-III criteria it is not obviously possible to exclude convincingly the presence of celiac disease at patients with symptoms of IBS with diarrhea and mixed type. It is expedient to recommend a test for antibodies to tissue transglutaminase and antibodies to endomysium to these patients.
References
1. Баранская Е.К. Синдром раздраженного кишечника: диагностика и лечение // Consilium medicum. – 2000. – Т. 2, № 7. – С. 25–29.
2. Парфенов А.И. Глютенчувствительная целиакия – от диагноза к лечению // Рус. мед. журн. – 2007. – № 6. – С. 458–464.
3. Парфенов А.И., Крумс Л.М., Сабельникова Е.А. Современная концепция, дефиниция и классификация целиакии: Материалы V съезда науч. об-ва гастроэнтерологов России. – М.: Анахарсис, 2005. – С. 473–475.
4. Хомерики С.Г. Патогенетические особенности и морфологические проявления целиакии // Consilium medicum. – 2007. – (прил. 1 «Гастроэнтерология»). – С. 34–37.
5. Agardh D. Antibodies against synthetic deamidated gliadin peptides and tissue transglutaminase for the identification of childhood celiac disease // Clin. Gastroenterol. Hepatol. – 2007. – Vol. 5, N 11. – P. 1276–1281.
6. Alonso Cotoner C., Casellas Jorda F., Chicharro Serrano M.L. Iron deficiency: not always blood losses // An. Med. Interna. – 2003. – Vol. 20, N 5. – P. 227–231.
7. Barclay L. Celiac disease linked to irritable bowel syndrome // Arch. Intern. Med. – 2009. – Vol. 169. – P. 651–658.
8. Camilleri M. Management of the irritable bowel syndrome // Gastroenterology. – 2001. – Vol. 120. – P. 652–668.
9. Carroccio A., Brusca I., Iacono G. et al. IgA anti-actin antibodies ELISA in coeliac disease: a multicentre study // Dig. Liver Dis. – 2007. – Vol. 39, N 9. – P. 818–823.
10. Chang F.Y., Lu C.L., Chen C.Y., Luo J.C. Efficacy of dioctahedral smectite in treating patients of diarrhea-predominant irritable bowel syndrome // J. Gastroenterol. Hepatol. – 2007. – Vol. 22, N 12. – P. 2266–2272.
11. Chey W.D. The complicated functional bowel disease patient: centrally acting agents and other treatment modalities // AGA Institute spring postgraduate course syllabus «Applying new evidence to clinical practice». – 2009. – P. 913–946.
12. Cook H.B., Burt M.J., Collett J.A. et. al. Adult coeliac disease: prevalence and clinical significance // J. Gastroenterol. Hepatol. – 2000. – Vol. 15, N 9. – P. 1032–1036.
13. Corazza G.R., Villanacci V. Coeliac disease // J. Clin. Pathol. – 2005. – Vol. 58. – P. 573–574.
14. Crowe S.E. Recognising and managing celiac sprue // AGA Institute spring postgraduate course syllabus «Applying new evidence to clinical practice». – 2009. – P. 665–694.
15. Drossman D.A. The functional gastrointestinal disorders and the Rome III process // Gastroenterology. – 2006. – Vol. 130, N 5. – P. 1377–1390.
16. Dupont C., Foo J.L., Garnier P. et al. Oral diosmectite reduces stool output and diarrhea duration in children with acute watery diarrhea // Clin. Gastroenterol. Hepatol. – 2009. – Vol. 7, N 4. – P. 456–462.
17. Green P.H.R., Stavropoulos S.N., Panagi S.G. et al. Characteristics of adult celiac disease in the USA: results of a national survey // Am. J. Gastroenterol. – 2001. – Vol. 96, N 1. – P. 126–131.
18. Lindh E., Ljunghall S., Larsson K. et al. Screening for antibodies against gliadin in patients with osteoporosis // J. Intern. Med. – 1992. – Vol. 231. – P. 403–406.
19. Longstreth G.F., Drossman D.A. Severe irritable bowel and functional abdominal pain syndromes: managing the patient and health care costs // Clin. Gastroenterol. Hepatol. – 2005. – Vol. 3, N 4. – P. 397–400.
20. Maiuri L., Ciacci C., Ricciardelli I. et al. Unexpected role of surface transglutaminase type II in celiac disease // Gastroenterology. – 2005. – Vol. 129, N 5. – P. 1400–1413.
21. Marsh M.N. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiological approach to the spectrum of gluten sensitivity // Gastroenterology. – 1992. – Vol. 102, N 1. – P. 330–354.
22. Marsh M.N., Crowe P.T. Morphology of the mucosal lesion in gluten sensitivity // Baillieres Clin. Gastroenterol. – 1995. – Vol. 9. – P. 279.
23. Mazzarella G., Maglio M., Paparo F. et al. An immunodominant DQ8 restricted gliadin peptide activates small intestinal immune response in in vitro cultured mucosa from HLA–DQ8 positive but not HLA–DQ8 negative coeliac patients // Gut. – 2003. – Vol. 52. – P. 57–62.
24. McCann J.P., Nicholls D.P., Verzin J.A. Adult coeliac disease presenting with infertility // Ulster Med. J. – 1988. – Vol. 57. – P. 88–89.
25. Meloni G.F., Dessole S., Vargiu N. et al. The prevalence of coeliac disease in infertility // Hum. Reprod. – 1999. – Vol. 14. – P. 2759–2761.
26. Murray J.A. Celiac disease in patients with an affected member, type 1 diabetes, iron-deficiency, or osteoporosis? // Gastroenterology. – 2005. – Vol. 128, N 4. – P. 147.
27. Pastore S. et al. Anti-tissue transglutaminase antibodies and infectious diseases in children // Focused Clinical Updates. Digestive disease week. – 2008. – Abstract S1254.
28. Patterson R.N., Johnston S.D. Iron deficiency anemia: are the British Society of Gastroenterology guidelines being adhered to? // Postgrad. Med. J. – 2003. – Vol. 79, N 930. – P. 226–228.
29. Rostani K., Kerckhaert J., Blomberg B.M.E. et al. Sensitivity of antiendomysium and antigliadin antibodies in untreated celiacs: diapointing in clinical practice // Am. J. Gastroenterol. – 1990. – Vol. 94. – P. 888–894.
30. Rostom A., Dube C., Cranney A. et al. The diagnostic accuracy of serological tests for celiac disease: A systematic review // Gastroenterology. – 2005. – Vol. 128, N 4, suppl. 1. – P. 38–46.
31. Schwertz E., Kahlenberg F., Sack U. et al. Serologic assay based on gliadin-related nonapeptides as a highly sensitive and specific diagnostic aid in celiac disease // Clin. Chem. – 2004. – Vol. 50, N 12. – P. 2370–2375.
32. Spiegel B.M., DeRosa V.P., Gralnek I.M. et al. Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis // Gastroenterology. – 2004. – Vol. 126, N 7. – P. 1721–1732.
33. Sugai E. et al. Celiac disease serology with very high accuracy may obviate diagnostic intestinal biopsy in different clinical scenarios // Focused Clinical Updates. Digestive disease week. – 2008. – Abstract M1212.
34. Tursi A., Brandimarte G. The symptomatic and histologic response to a gluten-free diet in patients with borderline enteropathy // J. Clin. Gastroenterol. – 2003. – Vol. 36, N 1. – P. 13–17.
35. Van Koppen Ellen J. et al. Long-term health and quality-of-life consequences of mass screening for childhood celiac disease: A 10-year follow-up study // Pediatrics. – 2009. – Vol. 123. – P. 582–588.
36. Yao-Zong Y., Shi-Rong L., Delvaux M. Comparative efficacy of dioctahedral smectite (Smecta) and a probiotic preparation in chronic functional diarrhea // Dig. Liver Dis. – 2004. – Vol. 36, N 12. – P. 824–828.
Review
For citations:
Shulpekova Yu.O., Baranskaya Ye.K. Differential diagnostics of irritable bowel syndrome and celiac disease. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2009;19(6):39-48. (In Russ.)
Views:
18
Email this article 
