Ford, A. C. et al. Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome. Arch. Intern. Med. 169, 651–658 (2009).

The prevalence of biopsy-proven celiac disease in individuals with IBS is more than fourfold that in people without IBS, report Alexander Ford and colleagues. Symptoms of IBS and celiac disease are similar—both include abdominal pain, bloating, and diarrhea.

Conflicting evidence exists as to whether celiac disease is increased in people with IBS, which prompted Ford et al. to conduct a systematic review and meta-analysis to address this issue. The authors included case series and case–control studies that used serologic tests for celiac disease. All positive cases were extracted and pooled, and celiac disease in cases (with IBS) and controls (without IBS) were compared using odds ratios.

14 studies were eligible for inclusion, in which 2,278 individuals met diagnostic criteria for IBS. 4% of individuals had serologically proven celiac disease and 4.1% had biopsy-proven celiac disease. The odds ratio for serology-proven celiac disease in cases versus controls was 3.4 and the odds ratio for biopsy-proven celiac disease in cases versus controls was 4.34. “The prevalence of biopsy-proven celiac disease in individuals who met diagnostic criteria for IBS was fourfold higher than for controls without IBS”, says Ford, who works at McMaster University, Canada. “Celiac disease should therefore be sought out and excluded before labeling individuals as suffering from IBS,” he continues.

“Future research should examine whether the increased prevalence of celiac disease in IBS is constant across the various subgroups of patients with IBS,” concludes Ford.